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Mental Health of Transgender Children Who Are Supported in Their Identities
Abstract
Objective:
Transgender children who have socially transitioned, that is, who identify as the gender "opposite" their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children.
Methods:
A community-based national sample of transgender, prepubescent children (n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures.
Results:
Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms.
Conclusions:
Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.
... Until recently it was rare for parents to acquiesce to their children's wish to transition, but this has been changing. Parents have become much more likely to allow their gender dysphoric children to socially and/or medically transition (see, e.g., de Graaf & Carmichael, 2019;Olson et al., 2016). For example, minor children may be given puberty-delaying hormones with parents' permission. ...
... Google Scholar reports 78,800 citations for the search term "parent reports," as of April 12, 2022. Research on gender dysphoria has also often included parent reports (e.g., Arnoldussen et al., 2020;Olson, 2016;Wallien & Cohen-Kettenis, 2008;Zucker & Bradley, 1995). Researchers have also long acknowledged the imperfections-including both incomplete information and biases-associated with parent reports (Achenbach et al., 1987). ...
During the past decade there has been a dramatic increase in adolescents and young adults (AYA) complaining of gender dysphoria. One influential if controversial explanation is that the increase reflects a socially contagious syndrome: Rapid Onset Gender Dysphoria (ROGD). We report results from a survey of parents who contacted the website ParentsofROGDKids.com because they believed their AYA children had ROGD. Results focused on 1655 AYA children whose gender dysphoria reportedly began between ages 11 and 21 years, inclusive. These youths were disproportionately (75%) natal female. Natal males had later onset (by 1.9 years) than females, and they were much less likely to have taken steps toward social gender transition (65.7% for females versus 28.6% for males). Pre-existing mental health issues were common, and youths with these issues were more likely than those without them to have socially and medically transitioned. Parents reported that they had often felt pressured by clinicians to affirm their AYA child’s new gender and support their transition. According to the parents, AYA children’s mental health deteriorated considerably after social transition. We discuss potential biases of survey responses from this sample and conclude that there is presently no reason to believe that reports of parents who support gender transition are more accurate than those who oppose transition. To resolve controversies regarding ROGD, it is desirable that future research includes data provided by both pro- and anti-transition parents, as well as their gender dysphoric AYA children.
... Additionally, where trans young people are accessing gender-affirming medical care, they are often supported or legally required to have a parent attend these appointments. For trans young people, being supported by their parents in their gender identity is critical for mental health outcomes (Travers et al., 2012), being able to socially transition (Olson et al., 2016), and to access services where parental consent is needed. Optimal gender-affirming medical care requires a holistic approach from a multidisciplinary team with interdisciplinary coordination (i.e., primary health, endocrinology, mental health, voice and communication as well as gynaecology/andrology) (Coleman et al., 2022). ...
... Parents who were able to learn about gender diversity and their child's needs in a supportive and encouraging mental health service environment were better able to support and affirm their child's gender identity at home (Menvielle & Rodnan, 2011). Parental support of their child's gender identity is a key protective factor for mental health in trans youth, Olson et al. (2016) reported that socially transitioned trans children supported in their identity by their parents were reported to have normative depression levels. A study by Miller et al. (2023) has also shown that a supportive family environment is associated with a decreased likelihood of a school-aged trans young person experiencing suicidal ideation. ...
Background
Many trans young people seek mental health support and gender-affirming medical interventions including puberty suppression, gender-affirming hormones and/or surgeries. Trans young people and their parents face multiple barriers in accessing gender-affirming care and mental health support, however little is known about the parent perspective on accessing services for their trans child.
Aims
This study aimed to understand the experiences of parents accessing medical and mental health services with and for their trans children within Australia.
Methods
Using data from Trans Pathways, a large mixed-methods cross-sectional study, we examined the experiences of parents (N = 194) in Australia accessing primary care, psychiatry, therapy/counseling, mental health inpatient, and gender-affirming medical services with/for their trans children (aged 25 years or younger). Qualitative data on service experiences were thematically analyzed. Quantitative analyses included frequency of access to services, wait times, service satisfaction, and mental health diagnoses of the parents’ trans child.
Results
Services were mostly first accessed when the young person was between 12 and 17 years of age, with primary care physicians being the most accessed service. Parents reported that some practitioners were respectful and knowledgeable about gender-affirming care, and others lacked experience in trans health. Across all services, common barriers included long wait times, complicated pathways to navigate to access support, as well as systemic barriers such as sparsity of gender speciality services. Across services, parents reported feeling as though they do not have the necessary tools to best support their child in their gender affirmation.
Discussion
This study highlights the crucial need for systemic changes in the processes of accessing gender-affirming care and mental health support to enable access to appropriate and timely care. These findings also indicate the importance of improving individual practitioner knowledge around trans health, to enhance the support provided to trans young people and their parents.
... While it is important to understand the impacts of oppression on TGEY, it is also imperative to explore the resiliency and protective factors of TGEY. In all contexts (at home, school, and in society), TGEY who are supported in their identities have decreased rates of depression, suicidality, anxiety, psychological distress, behavioral symptoms, drug use, and increased access to healthcare, housing, and financial security (Ehrensaft, 2014;Hatchel & Marx, 2018;Human Rights Campaign Foundation, 2018;James et al., 2016;Mustanski & Liu, 2013;Olson et al., 2016;Smith et al., 2014;Travers et al., 2012;Turban & Ehrensaft, 2018). Children who have been allowed to socially be their true gender often show a reduction in anxiety, depression, and defiance, and an increase in happiness, contentment, self-worth, and well-being (Durwood et al., 2017;Ehrensaft, 2014). ...
... Additionally, evidence suggests positive mental health outcomes for TGEY who have socially gone through the affirmation process and have supportive parents and caregivers (Durwood et al., 2017;Ehrensaft, 2014). These studies show that psychopathology is not inevitable in this population and is often due to societal oppression (Olson et al., 2016). ...
This manuscript is a part of a four-manuscript series that shares the findings from the first known Interpretative Phenomenological Analysis (IPA) study on how transgender and/or gender expansive youth (TGEY) experienced their gender identities and additional intersecting identities within the context of current political, social, cultural, and historical factors. This manuscript explores the resiliency and meaning-making factors of TGEY. Data was collected through two 60–90-minute semi-structured interviews. Within this overarching theme of resiliency factors, two sub-themes emerged that focused on the participants’ creativity, and the ways they engaged in activism and education.
... Le traducteur et le comité de traduction de GLAD! 1 L'idée voulant que de jeunes personnes transgenres réaliseraient des coming out « venus de nulle part » après avoir été exposé·es aux communautés trans n'est pas nouvelle, mais n'a que récemment été labelisée sous la catégorie pseudo-diagnostique politisée de « rapid-onset gender dysphoria » (ROGD). Dès son invention en 2016, le terme reflète un effort délibéré d'arsenaliser 12 un langage aux apparences scientifiques de manière à pouvoir discréditer l'accumulation grandissante de preuves sur les bénéfices de la transition chez les adolescent·es (voir par exemple Lily Durwood, Katie McLaughlin et Kristina Olson, 2017 ;Ximena Lopez et al., 2017 ;Kristina Olson et al., 2016 ;Michelle Telfer et al., 2018 ;Jack Turban et al., 2020 ;What We Know, s. d.). En présentant un compte-rendu critique du processus social par lequel le concept de ROGD a été créé et propagé, et en mettant à jour les parallèles avec la mobilisation politique de langage d'apparence scientifique dans les cas du Syndrome d'Aliénation Parentale et du Syndrome des Faux Souvenirs, cet article contribue aux débats sociologiques plus larges sur la nature du discours scientifique. ...
... Comme j'espère l'avoir montré, les affirmations inquiétantes liées à la ROGD cachent un désert de preuves empiriques. Plutôt que comme une inquiétude scientifique légitime, la ROGD doit se comprendre comme une tentative de mobiliser un langage scientifique pour contourner l'accumulation de preuves en faveur de l'affirmation de genre(Durwood, McLaughlin et Olson, 2017 ; Lopez et al., 2017 ;Olson et al., 2016 ;Telfer et al., 2018 ;Turban et al., 2020 ; What We Know, s. d.), via la création d'un sous-groupe clinique auquel les données existantes ne s'appliqueraient prétendument pas. La collecte de nouvelles données prenant des années, cette stratégie discursive peut être employée pour justifier l'opposition à l'affirmation de genre et faire pression sur les adolescent·es pour qu'iels s'identifient au genre qui leur a été assigné à la naissance, une pratique assimilable aux thérapies de conversion. ...
The term ‘rapid-onset gender dysphoria’ (ROGD) was coined in 2016 to describe an alleged epidemic of youth coming out as trans ‘out of the blue’ due to social contagion and mental illness. The term reflects a deliberate attempt to weaponise scientific-sounding language to dismiss mounting empirical evidence of the benefits of transition. This article offers an introduction to the theory of ROGD and its history, presents a detailed critique of the empirical and theoretical claims associated with the theory, and highlights structural concerns with the ROGD discourse. The article argues that claims associated with ROGD, including assertions of declining mental health and degrading familial relationships following coming out, are best explained by the leading ROGD study’s recruitment of parents from transantagonistic websites against a background of growing visibility and social acceptance of trans people. ROGD theory is best understood as an attempt to circumvent existing research demonstrating the importance of gender affirmation, relying on scientific-sounding language to achieve respectability.
... The consequences of this lack of understanding and support range from a higher rate of suicide attempts compared to the rest of the population to a greater probability of suffering bullying and school dropout, physical violence, etc. (Grant et al., 2011). However, when these minors are supported and accompanied in their social transition, they have quality of life indicators similar to the rest of the population and much better than those trans children who have not undergone this process (Olson et al., 2016). ...
... This increase in the media attention may have helped to make trans children and adolescents thinkable (Mayor et al., 2018). In addition, it may also have indirectly facilitated the social transition of these minors and that they have been supported and accompanied in this process (Pang et al., 2020), thus contributing to improving their quality of life indicators (Olson et al., 2016). On the other hand, media attention on trans minors and on trans issues in general are related (Hypothesis 2), being to a certain extent parallel, as suggested by Riggs and McIntyre (2022). ...
The increase in media attention towards trans issues in the last two decades has contributed to reinforcing its visibility. However, the media coverage of trans minors has hardly been addressed by previous literature. The objective of this study is to analyze the media coverage of trans children and adolescents in the Spanish digital press during the period 2006–2020. To do that, this article has conducted a quantitative content analysis combining manual coding and rule-based text classification. The results confirm that the media coverage of trans minors has increased. Most of the analyzed delegitimization patterns of trans people have decreased over the years, although they remain relatively stable during the last period. Contrary to what could be thought, childhood and adolescence do not seem to act as a protective factor against media delegitimization. These findings suggest that trans children are at the front-page of Spanish public debate. Despite the increasing visibility of trans minors, they continue to be mistreated in the media. In fact, trans children may be even more questioned than adults. All in all, this study underlines the importance of trans minors in the news coverage of trans issues and, in extension, in the fight for trans rights.
Prior state of knowledge
Even if previous literature suggests that news media coverage seems to be associated with the number of trans children who go to clinical services to start their social transition, there is no longitudinal quantitative evidence on the news media representation of trans children.
Novel contributions
Neither childhood nor adolescence seem to act as a protective factor against media delegitimization. In fact, trans children may be even more questioned than adults and they have become a centerpiece for anti-trans media strategies.
Practical implications
The need to continue raising awareness among journalists about trans minors is underscored. Some possible courses of action could be the participation of journalists in the creation and dissemination of guidelines and the organization of asynchronous online courses and offline workshops.
... There is a bidirectional influence and impact between personal and family transition (Canitz & Haberstroh, 2022;Zamboni, 2006). On the one hand, people are relationally constructed, and the family can largely determine well-being and personal identity construction, as a person's psychological adjustment will be influenced by their perceived acceptance or rejection by their role models (Fuller & Riggs, 2018;Olson et al., 2016;Rohner & Lansford, 2017;Westwater et al., 2019). On the other hand, one person's gender transition affects the other family members (Barron & Capous-Desyllas, 2017;Katz-Wise et al., 2017), as it changes how the family functions as a system (von Doussa et al., 2020). ...
... Families can be a supportive context, fostering the trans person's well-being and acting as a protective factor for their mental health when facing minority stress (Fuller & Riggs, 2018;Olson et al., 2016). Likewise, the family must also cope with the impact of minority stress through the process and meaning-making, sometimes involving contradictory or difficult-to-manage situations such as ambiguous loss (Coolhart et al., 2018;Norwood, 2013;Wahlig, 2015). ...
Family can be a supportive and protective mental health context for trans children, yet little research, mainly qualitative, has focused on the experience of parents, who also suffer the impact of minority stress and live a process of meaning-making during gender affirmation process. This research aims to explore the impact of ambiguous loss and its relationship to their emotional intelligence and well-being. A mixed methods triangulation design with cross-sectional observation was used. Eighty-nine parents of transgender people participated in the study. The mean age was 46.37 years (S.D. = 7.15), 86.5% (n = 77) identified themselves as female and 44.4% reported a grieving process, although there were no statistically significant differences on well-being, emotional intelligence or emotional symptoms depending on it. However, parents with loss reported more negative emotions and do not benefit to the same extent from emotional intelligence or the buffering effect of positive emotions (especially pride). Perception of loss increases family distress, encouraging the gender affirmation process to be felt as a rupture and hindering the elaboration of new meanings. Future studies could include different personal, family, and contextual variables to further explore the experience of loss during the process, to assist these families more effectively.
... More than one third (n = 13) of the 33 included articles addressed internalized psychopathology such as depression and/or anxiety [12,14,[53][54][55]57,58,60,64,66,68,69,71,76]. The included contributions also addressed other mental health outcomes and/or problematic behavior such as attention deficit and/or hyperactivity disorder (ADHD) and conduct disorder (CD) [53], autism spectrum disorder (ASD) [53,63,66,73], eating disorders [53,66], trauma, harassment, bullying, and victimization [55,57,58,66,69,76,79], adverse childhood experiences (ACEs) [56,71], substance use [9,26,58,71,80], and sex trading [67]. ...
... For instance, Durwood and colleagues [14], found that, consistent with their parents' reports, TGD children reported higher levels of anxiety but not higher levels of depression and self-worth than their matched-control or sibling peers. In line with these results, Olson and colleagues [68], albeit finding higher levels of anxiety among TGD prepubescent children who had already socially transitioned if compared with their cisgender counterparts, also found that levels of depressive symptomatology were not significantly different between the two groups. ...
Although capable of mobilizing significant resilience factors to face stigma and discrimination, transgender and gender diverse (TGD) children and adolescents tend to suffer from more adverse mental health outcomes compared to their cisgender counterparts. The minority stressors that this population faces are mainly due to the gender-based pressure to conform to their assigned gender. This systematic review was aimed at assessing the potential mental health issues that affect the TGD population. The literature search was conducted in three databases; namely, Scopus, PubMed, and Web of Science, based on the PRISMA guidelines. The 33 articles included in the systematic review pointed out how TGD children and adolescents experience high levels of anxiety and depression, as well as other emotional and behavioral problems, such as eating disorders and substance use. Resilience factors have been also pointed out, which aid this population in facing these negative mental health outcomes. The literature review highlighted that, on the one hand, TGD individuals appear to exhibit high levels of resilience; nonetheless, health disparities exist for TGD individuals compared with the general population, which are mainly attributable to the societal gender pressure to conform to their assigned gender. Considerations for research and clinical practice are provided.
... 14 Conversely numerous studies have shown that GAMC improves mental health outcomes, reduces suicidality, and improves well-being of TGD children and adolescents. 15,16 Reports suggest an increase in number of referrals for GAMC for TGD children and adolescents and the need for resources and enhanced provider education to improve GAMC. 17 In response, clinical practice guidelines have been developed by the Endocrine Society to help guide GAMC. ...
... Identification of TGD is especially important as GAMC has the potential to improve mental health outcomes, reduce suicidality, and improve well-being for TGD children and adolescents. 15,16 As care for those with EDS is often complex and multidisciplinary, providers should take consideration to ask relevant screening questions to identify gender identity and to ensure gender-affirming healthcare environments that contribute to improved care and outcomes. 19 There have been many reports that impairments are present in the psychosocial and emotional functioning in children and adolescents with TGD, 13 including higher rates of depression, suicidality, self-harm, and eating disorders. ...
Objectives
Ehlers–Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers–Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers–Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers–Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers–Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic.
Methods
A retrospective chart review was performed and it was found that 28 patients were seen in the Ehlers–Danlos Syndrome multidisciplinary clinic were reported being transgender and gender diverse. Chart review included analysis of all documents in the electronic medical record, including demographic data, gender identity, chosen pronouns, specialty care previously received for Ehlers–Danlos Syndrome, symptoms and conditions related to it, and medications.
Results
Of the 166 total adolescents seen in the pediatric multidisciplinary Ehlers–Danlos Syndrome clinic during the study period, 17% reported gender dysphoria. The average age at Ehlers–Danlos Syndrome diagnosis was 13.5 years (range 8–17 years). Most (61%) reported their gender identity as transgender, followed by nonbinary (14%). Most had preferred male (he/him) pronouns (47%), followed by nonbinary (they/them) pronouns (39%). The vast majority reported fatigue (75%), musculoskeletal issues (96%), psychiatric issues (86%), cardiac issues (71%), gastrointestinal issues (68%), and neurologic issues (79%).
Conclusions
Here we report the first cohort of transgender and gender diverse adolescents in the Ehlers–Danlos syndrome population and show an association between the two. This report increases awareness for providers who care for patients with Ehlers–Danlos Syndrome. As care for those with Ehlers–Danlos Syndrome is often complex and multidisciplinary, providers should adopt practices of gender-affirming medical care that contribute to improved care and outcomes.
... Comprehensive mental health support of LGBT individuals generally, and TGNC individuals specifically, requires understanding of both the increased risk factors for mental health diagnoses and the psychosocial factors that perpetuate this risk (Pepping et al., 2019;Edwards-Leeper et al., 2016;Olson et al., 2016). Collectively, these competencies are known as an affirmative approach to mental health care; training in affirmative care may orient mental health professionals to the psychological and social factors that are a part of coming out, the differences between a heterosexual and same-sex relationship, and issues that religious LGBT-individuals face. ...
... Continued research on the efficacy of affirmative therapy is needed, but anecdotal evidence suggests that this approach to mental health care is promising (Grzanka, & Miles, 2016). In a sample of TGNC youth aged 3-12 (N = 73) who were affirmed in their identities by their families and peers, there were no significant differences in rates of anxiety and depression, as compared to the general population (Olson et al., 2016). This stands in contrast to earlier referenced research that indicates TGNC youth as having an elevated risk of anxiety and depression (Olson et al., 2015;Spack et al., 2012;Khatchadourian et al., 2016). ...
Youth who identify as transgender, gender non-conforming, or non-binary (TGNC) are at increased risk for mental health challenges including anxiety, depression, and suicidality; and social challenges including bullying, isolation, and lack of familial support. Best practices in promoting the social and emotional health of TGNC youth are continually evolving, and Animal Assisted Therapy (AAT) presents a compelling yet untested approach to meeting mental health needs of this population; a group AAT intervention might help TGNC youth who feel isolated to feel more connected and supported. This exploratory study sought to identify thematic content to be included in a future AAT group intervention geared towards TGNC youth, considering both the potential role of human-animal interactions and the identified needs of this population. Three focus groups were convened; one comprised of TGNC adults (N = 8), one of mental health clinicians with advanced training related to transgender mental health (N = 4), and one of certified Animal Assisted Play Therapists® (N = 5). The content of each group was coded thematically using modified grounded theory, and several subthemes emerged under broader themes of 1) the importance of animals in providing emotional support in general and 2) desired social supports that might be beneficial for TGNC youth. These themes inform discussion of possible next steps in the development of an AAT group for TGNC youth.
... health of TGD adolescents and young adults (AYA) is not an aspect of their identity, but resulting from chronic negative, invalidating, and unsupportive experiences in their environment. Research has shown that TGD AYA have similar mental health outcomes as their cisgender siblings when living in an environment that is affirming (e.g., supportive, validating) of their gender identity (Olson et al., 2016). Still, there exists a disproportionate representation of mental health conditions among TGD AYA, including depression, suicidality, self-injurious behavior, and suicide attempts (Connolly et al., 2016). ...
Purpose
There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma.
Methods
Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing.
Results
Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation.
Conclusion
NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.
... Esta información "debe darse con el objetivo de que la pequeña o joven persona, sus 35 El modelo afirmativo parte de la base de que la creatividad de género es una expresión más de la diversidad humana y que, por tanto, su problematicidad reside en el contexto sociocultural en el que vive la pequeña persona y no en dicha persona. (Ehrensaft 2014;Hidalgo et al. 2013;Hill et al. 2010;Hill y Menvielle 2009;Malpas 2011;Menvielle y Gomez-Lobo 2011;Olson et al. 2016). El modelo afirmativo considera que la criatura debe poder expresar su género e identidad libremente, en el modo en que lo considere oportuno, a cualquier edad, sin tener que esperar necesariamente a la pubertad. ...
Until recently, talking about transgender children was only accepted and described in medical terms as a pathology to be prevented and treated. Although this interpretative framework still prevails today, we are witnessing an important epistemological change that fosters the recognition of this experience as an expression of human diversity to be claimed first and foremost by families. From the sociological point of view, we are dealing with a new phenomenon. This is the first generation of parents who choose to support and accompany their transgender not just at home but in public, thus facing unexplored paths and heading to unknown destinations. This thesis aims to describe how parenting a transgender child takes shape from the voices of those directly involved: the families. My research takes place in the Catalan and the Italian contexts, which are very close in cultural, historical, and economic terms, but show remarkable differences when it comes to the object of this study. The world of associations, the current medical model, and the legislative instruments designed to protect young gender variant people are organized differently in Catalonia and in Italy and can deeply affect the way families attribute meaning to their children's experience and the way they accompany them. Ethnography is the method chosen to develop this work because it gives researchers closer access to the reality they want to describe and the opportunity to show the reality based on the meanings, language, and relationships of the social actors that constitute the subject of study. The analysis of the interviews, which is the central part of the thesis, highlights such elements as the emotions felt by the parents, their ethical reflections when confronted with the breaking of the gender norm by their children, the social meanings attributed to them by the available discourses and the practical strategies activated to create legitimate and socially recognized possibilities of existence.
Hasta hace unos años, hablar de infancia trans* era concebible únicamente dentro de un marco médico, que consideraba este tipo de experiencias una patología que había que prevenir y tratar. Aunque este sigue siendo hoy el principal campo de conocimiento desde el que se desarrolla el discurso sobre lo trans* en la infancia, estamos asistiendo a un importante cambio epistemológico que lleva a reconocer estas experiencias como una mera expresión de la diversidad humana que debe ser afirmada, ante todo, por las familias. Desde el punto de vista sociológico, estamos ante un fenómeno nuevo. Se trata de la primera generación de progenitores que opta por apoyar y acompañar a sus hijes trans* y que lo hace de forma pública, navegando por caminos hasta ahora inexplorados y de destinos inciertos. Esta tesis pretende describir cómo toma forma la crianza de criaturas trans* a partir de las voces de las personas directamente implicadas, las familias. He situado la investigación en dos contextos, el catalán y el italiano, muy próximos entre sí en cuanto a cultura, historia y economía, pero que presentan importantes diferencias por lo que se refiere al objeto de estudio de esta tesis. El mundo asociativo, el modelo médico actual y los instrumentos legislativos destinados a proteger a las pequeñas personas trans* se organizan de forma diferente en Catalunya y en Italia, y contribuyen a determinar el modo en que las familias atribuyen un significado a la experiencia de su prole, así como el modo en que la acompañan. La etnografía es el método elegido para desarrollar este trabajo por su capacidad de acercar a la persona investigadora a la realidad que desea describir, permitiéndole emerger a través de los significados, el lenguaje y las relaciones de los actores sociales que conforman el objeto de estudio. El análisis de las entrevistas, que constituye la parte principal de esta tesis, pone de relieve las emociones que sienten madres y padres, las reflexiones éticas que surgen cuando se enfrentan a la ruptura de la norma de género por parte de sus criaturas, los significados sociales que los discursos disponibles les atribuyen y las estrategias prácticas.
... A constituição de si-mesmo de João teria percorrido os mesmos caminhos caso houvesse a possibilidade do reconhecimento do seu gesto espontâneo? Não há como responder essa questão, porém a contemporaneidade nos desvela interessantes dados que demonstram uma redução de sintomas psiquiátricos, um aumento dos aspectos de saúde mental e menores índices de disforia de gênero em crianças transexuais que recebem apoio, reconhecimento e cuidado ambiental (Travers et al., 2012;Olson et al., 2016;Zerbinati & Bruns, 2018;Tordoff et al., 2022). ...
Resumo: A transexualidade é um fenômeno que ultrapassa a barreira mecânica do ser e do existir, sobretudo, no que diz respeito à sexualidade e ao gênero. Muito discutido na literatura internacional, seja pelo viés biológico, médico ou das ciências humanas, tal fenômeno dimensiona a importância do cuidado físico e mental para promoção de qualidade de vida. Neste artigo pretendeu-se compreender os aspectos ligados ao desenvolvimento emocional na transexualidade. Para isso, analisou-se a vivência do primeiro transexual brasileiro, João Nery, através da psicanálise de paradigma pós-winnicottiano. O mundo vivido de João Nery é uma caminhada árdua em busca de si-mesmo. Seus dilemas, conflitos, desejos, sonhos, paixões, sofrimentos, lutas e alegrias desvelam uma postura espontânea com a identidade sexual e de gênero. A transexualidade aqui compreendida apresenta horizontes de disponibilidade à criação, de matizes originais e à ruptura com as sólidas estruturas da cishetonormatividade. No horizonte trans, de viés subjetivo, da ruptura patologizante ao matiz da criação, a transidentidade pode representar um processo subjetivo, criativo, de busca da constituição do verdadeiro self. Palavras-chave: Transexualidade; Desenvolvimento emocional; Psicanálise; Winnicott. Abstract: Transsexuality is a phenomenon that goes beyond the mechanical barrier of being and existing, especially with regard to sexuality and gender. Much discussed in the international literature, whether from a biological, medical or human science perspective, it scales the importance of physical and mental care to promote quality of life. This article intended to understand the aspects related to emotional development in transsexuality. For this, it analyzed the experience of the first Brazilian transsexual, João Nery, through the psychoanalysis of a post-winnicottian paradigm. João Nery's lived world is an arduous journey in search of himself. Their dilemmas, conflicts, desires, dreams, passions, sufferings, struggles and joys reveal a spontaneous attitude towards sexual and gender identity. The transsexuality understood here presents horizons of availability to the creation, of original nuances and the rupture with the solid structures of cishetonormativity. In the trans horizon, with a subjective bias, from the pathologizing rupture to the nuance of creation, transidentity can represent a subjective, creative process, in search of the constitution of the true self.
... A decrease in depressive symptoms, emotional problems and general functioning improvement were seen [97]. Moreover, Olson et al. highlighted similar mental health outcomes between socially transitioned prepubertal TG children and cisgender peers [98] Recent studies have reported increased rates of gender diversity in the population of children and adolescents diagnosed with ASD compared to non-ASD peers (4-5.4% vs. 0.7%) [89][90][91][92]99]. Other studies conducted among children, adolescents and adults have identified a positive association between GD and ASD in a rate between 4.8 and 26% [100][101][102][103][104]. ...
While the significance of gender has only recently been recognized, gender assigned at birth has long been understood to have a significant influence on a number of illnesses. Due to the paucity of data in this regard in pediatrics, the purpose of this narrative review is to frame the most recent knowledge about the role of gender assigned at birth in the neurological development and neuropsychiatric disorders among young people. Literature analysis showed that gender disparities exist in neurologic and neuropsychiatric disorders among the pediatric population and supported the fact that new guidelines should take this into account. However, there is an urgent need for specific studies focused on gender role among children and adolescents in order to better understand how this can relate to diagnosis, development and treatment of different neurologic and neuropsychiatric diseases. Moreover, further efforts should be directed to identify unique risks linked to gender disorders and gender dysphoria as well as taking into account a gender point of view when approaching a pediatric patient.
... In an informed consent model, a medical provider discusses a patient's history and care goals, provides education about the medical treatment, ensures patient understanding and reviews consent detailing the effects of treatment before prescribing GAH. 33 A patient would not be required to meet with a mental health provider or obtain a letter of support before initiating pubertal suppression or GAH. Instead, individuals can access hormones after completing hormone education and reviewing treatment consent in a single appointment with a medical provider. ...
Transgender and gender diverse (TGD) youth and their families are seeking medical and mental health care at increasing rates. As the number of multidisciplinary pediatric gender programs expands, we consider the history and evidence base for gender affirmative care and highlight existing models of care that can flexibly accommodate the diverse needs of TGD youth and their families. Comprehensive multidisciplinary care includes both medical and mental health providers who work collaboratively with TGD youth and their caregivers to assess gender-related support needs and facilitate access to developmentally appropriate medical and mental health interventions. In addition to direct health-care services, multidisciplinary care for TGD youth and their families extends into community training, education, community outreach, nonmedical programming, and advocacy for TGD youth.
... Family rejection of LGBT children, on the other hand, "has been associated with lower self-esteem, isolation, and poorer mental health outcomes" (Ryan, 2009, cited in Frigerio et al., 2021. Hence, supporting an adolescent's well-being is often perceived as a moral imperative (Frigerio et al., 2021;Olson et al., 2016). ...
Matters of parenting transgender children are ascendant on the cultural landscape. Based on interviews with Israeli mothers of transgender children between the ages of 8–24 I explore how the process of the child's gender affirmation intersects with maternal subjectivities, and how mothers internalize the morally‐loaded narratives of good mothering in contemporary Israel. I illustrate that when children undergo gender affirmation, mothers experience their mothering as challenged and transformed. This transformative process can be conceptualized in terms of political becoming and ethical self‐formation (Foucault 1997). However, such a conceptualization does not fully encompass the complexity of mothers' daily carework. An anthropological approach, in particular the concept of "moral moods" (Throop 2014), can best capture the spontaneity and ambiguity of mothers' moral lives. This concept can be a valuable theoretical tool to grasp the diffused affective states and moral concerns of those who are constantly subjected to the critical gaze.
... Durante este tiempo, se programa la identidad de género (el sentimiento de ser hombre o mujer), la orientación sexual y otros comportamientos. Como la diferenciación sexual de los genitales tiene lugar en los primeros 2 meses de embarazo, y la diferenciación sexual del cerebro comienza durante la segunda mitad del embarazo, estos dos procesos pueden verse influenciados independientemente el uno del otro, lo que resulta en Las anteriores posturas teóricas se han presentado históricamente como mutuamente excluyentes e imposibles de conciliar y alrededor de ellas están los estudios sobre condiciones bio-psicosocioculturales, los cuales conforman un conjunto amplio de estudios de sujetos "trans" o "no binarios" asociados con diversas condiciones como la salud física, especialmente aspectos relacionados a la terapia de remplazo hormonal y endocrinología (Dahl, Feldman, Goldberg y Jaberi, 2006;Bradford, Reisner, Honnold y Xavier, 2013;den Heijer, Bakker y Gooren, 2017), VIH y factores de riesgo (De Santis, 2009), salud mental y psiquiatría (Zarazúa, Salinas, Negrete y Ruíz, 2015;Grossman y D'Augelli, 2007;Prunas, et al. 2014;Heylens, et al. 2014) aspectos oncológicos (Gooren, Bowers, Lips y Konings, 2015), aspectos pediátricos (Castilla-Peón, 2018;Olson, Durwood, DeMeules y McLaughlin, 2016), aspectos del bienestar/malestar psicosocial (Bockting, Miner, Swinburne, Hamilton y Coleman, 2013;Boza y Nicholson, 2014;Rimes, Goodship, Ussher, Baker y West, 2019;Bouman, et al. 2017;Stewart, O'Halloran y Oates, 2018), así como de estándares y protocolos de acompañamiento bio-psico-social (Coleman, et al. 2012;Dèttore, et al. 2015;López-Guzmán, 2018;Ehrensaft, Giammattei, Storck, Tishelman y Keo-Meier, 2018;Domínguez, Ramírez y Arrivillaga, 2018;Ortega-Pavesio, 2019). ...
El propósito del presente trabajo es exponer los argumentos más representativos del concepto de ciudadanía sexual y sus implicaciones para el ejercicio de derechos de personas que viven discordancia de género particularmente en México. Se detalla un recorrido teórico que invita a la reflexión crítica de los desafíos en la construcción de ciudadanía sexual basada en el sistema binario del sexo y del género, así como para el estudio de las diversidades sexuales. Concluyendo, por un lado, que en la actualidad el sistema binario está siendo rebasado y, por otro lado, se está abriendo la oportunidad de desnaturalizar, desesencializar y tal vez desbinarizar las identidades de género.
... Counseling; cognitive-behavioural therapy; trauma-focused; affirmative counseling; trauma; transgender; minority stress; victimization; gender diverse It is well documented that transgender and gender diverse (TGD) individuals are at increased risk for negative mental health outcomes relative to cisgender individuals, including higher rates of mood and anxiety disorders, posttraumatic stress disorder (PTSD), substance use disorders, eating disorders, self-harm, and suicidality (Becerra-Culqui et al., 2018;Carmel & Erickson-Schroth, 2016;Coker et al., 2010;Connolly et al., 2016;Olson et al., 2016;Reisner et al., 2015;Veale et al., 2017). This heightened vulnerability is due in part to the marginalizing nature of the social environment in which many TGD individuals live, involving disproportionate rates of discrimination and victimization across societal, institutional, and interpersonal domains (Chodzen et al., 2019;Craig & Austin, 2016;J€ aggi et al., 2018;Tan et al., 2020). ...
This article describes an innovative, trauma-focused cognitive behavioral protocol, Transcending, to address the effects of minority stress on mental health among transgender and gender diverse individuals. The protocol merges minority stress and cognitive behavioral therapy models to provide a framework for (a) understanding the impact of minority stress (i.e., distal and proximal stressors) and (b) developing skills to address maintenance factors of associated psychological distress. The Transcending protocol is intended to provide a structured approach to filling an important gap in counseling services and increasing therapeutic competence with transgender and gender diverse individuals.
... For transgender 1 youth, the development of their bodies accompanies their identity, not only through its effect on interactions with the world but also through the internal sensations that shape body awareness (Langer, 2019). In this regard, some authors (e.g., Durwood et al., 2017;Kozee et al., 2012;Olson et al., 2016) have raised the importance of understanding the bodily experience of transgender people, particularly from a phenomenological perspective and beyond the aesthetic or biological aspects. These authors have found that changes related to the affirmation of felt genderconcordant corporeality have an impact on deep psychological aspects, capable of sustaining one's identity and regulating internalized stigma. ...
This article is a methodological proposal for Body Mapping application in transgender population framed by a phenomenological approach and aimed at exploring the implicit and pre-reflective embodied cues of the experience of discordance between the felt body (the body I am) and the objective body (‘the body I have’) that opens a space in which words do not have easy access to. In order to describe our protocol of phenomenological exploration and application of Body Mapping, we detail the complete process in a single case. It corresponds to a female-to-male participant of 18 years old undergoing hormonal treatment with testosterone for 12 months before engaging in our study. Reflections about the potential of using art-based research methods for accounting of pre-reflective bodily experience of discordance in transgender population are detailed. The combination of the Body Mapping art-based research tool with a phenomenological approach for the study of experience seems promising for studies aimed at exploring experience from an embodied approach. It represents a radical first-person research method in which the images talk by themselves. Furthermore, including the researchers as beholders of the resulting artwork, assuming the role of inter-corporality of the aesthetic bodily resonance as part of the data collection procedure seems innovative but loyal and honest with what an Art-based research paradigm is.
... 23,24 Only recently have studies considered protective factors among gender minority youth. 3,[25][26][27][28] Olson and colleagues 26 found that children who had socially transitionedconsidered as a protective factor and proxy for family support -did not report the same high depression and anxiety rates that had been documented in broader transgender youth samples. This finding was supported by a state-wide survey that found parent-connectedness was associated with lower odds of self-reported depression, substance use, and suicidality among gender diverse youth compared to those reporting lower levels of parent-connectedness. 25 Support from educational and trans communities has also been identified as salient for transgender youth. ...
Few studies have disentangled differences in victimization exposures and mental health symptoms among gender diverse subgroups, nor considered the role of potential protective factors in ameliorating the impact of victimization on gender diverse youths’ mental health. To address this gap, we analyze data (N = 11,264) from a population-based survey of youth in participating school districts in a large Midwestern U.S. county. Relative to cisgender youth with gender conforming expression, transgender youth and cisgender youth with nonconforming gender expression are more likely to experience victimization and severe mental health concerns. Additionally, school-connectedness moderates the association between bias-based harassment and depression for cisgender youth with gender nonconforming expression, and family support/monitoring buffers the association of peer victimization with suicide attempts among transgender youth. Findings highlight the need to better understand factors which may confer protection among gender diverse adolescents, so that in turn appropriate supports across key contexts can be implemented.
... In many households, primary caregivers may be biological parents and in others, parenting roles may be performed by other family members (Sear, 2016). We therefore encourage a broad and culturally-adapted definition of primary 1 Although we ask about parent gender identification, current research typically examines changes in gender identification starting at 3 years of age, beyond the age range that we focus on here (Olson et al., 2016). Thus, we focus on child's sex at birth as the target construct, recognizing that the question text and response options instantiating this construct will likely vary between communities. ...
Culture is a key determinant of children’s development both in its own right and for understanding the generalizability of developmental phenomena. Studying the role of culture in development requires information about participants’ demographic backgrounds. However, both reporting and treatment of demographic data are limited and inconsistent in child development research. A barrier to reporting demographic data in a consistent fashion is that no standardized tool currently exists to collect these data. Variation in cultural expectations, family structures, and life circumstances across communities make the creation of a unifying instrument challenging. Here, we present a framework to standardize demographic reporting for early child development (birth to 3 years of age), focusing on six sociodemographic construct categories: biological information, gestational status, health status, community of descent, caregiving environment, and socioeconomic status. For each, we discuss potential measurement items and provide guidance for their use and adaptation to different contexts. These items are stored in a repository of context-adapted questionnaires that provide a consistent approach to obtaining and reporting demographic information so that these data can be archived and shared in a more standardized format. The public significance of this work is to facilitate diversification of participants within developmental psychology by providing a framework for capturing demographic diversity.
... Parental rejection also has other serious, far-reaching impacts for trans youth; they are significantly over-represented across the areas of homelessness, sexual exploitation and the care system (Bateman, 2014;Choi et al., 2015;McCormick et al., 2016). Conversely, trans youth who are supported by their parents to live openly and express their identified gender show improvements in demeanor and wellbeing (Durwood et al., 2017), no elevation in depressive symptoms and only slightly elevated anxiety relative to population norms (Olson et al., 2016). ...
Parental support is strongly correlated with protective factors for trans youth yet most experience parental rejection or ambivalence regarding their gender. Many parents report a desire to support their child but indicate lack of understanding and support as key barriers. We aimed to develop a nuanced understanding of the challenges and facilitators experienced by Australian parents in developing understanding, support and acceptance of their child’s gender and their needs to do so. Using data from semi-structured interviews (N = 30), the General Inductive Approach (GIA) was employed to explore primary themes within parental narratives. Participants described a range of complex emotions and exhausting mental burden as they simultaneously supported their child, searched for information, and navigated multiple systems (e.g., school, health). Good-quality information, seeing positive change in their child once affirmed and peer connections were powerful facilitators for increased support. There was strong thematic unity regarding their needs. Parents reported wanting an online ‘one-stop hub’ with evidence-based information and resources, and access to others’ lived experiences. Better understanding of the parental experience and what parents need to optimally support their child holds implications for the development of online interventions to promote parental understanding, support and acceptance of a child’s gender.
... U ovom periodu su objavljeni i rezultati tzv. meksičke studije, koja pokazuju da se veća prevalenca psihičkih tegoba kod transrodnih osoba u odnosu na cisrodne može objasniti stigmatizacijom, odnosno izloženošću nasilju i diskriminaciji (Keating & Muller, 2020;Valentine & Shipherd, 2018;Robles et al., 2016), što je u skladu i sa rezultatima drugih istraživanja (Olson et al, 2016). Najvažniji korak u depsihopatologizaciji rodne različitosti pravi Svetska zdravstvena organizacija objavljivanjem jedanaeste verzije Međunarodne klasifikacije bolesti (ICD-11, 2019), koja bi od 2022. ...
Transgender people are one of the most stigmatized social groups. They are experiencing institutional stigma and stigma on the individual psychological level through different medical and legal procedures specific to their group. Though gender confirmation surgeries have been performed in Serbia for more than three decades, research on experiences and ways in which transgender people give meaning to the process is lacking. This topic became even more prominent due to significant changes in the area of depychopathologization of gender diversity and individualization of the medical gender confirmation process. This paper presents the experiences of transgender people in Serbia throughout the medical gender confirmation process and analyses the ways in which transgender people experience the process and give meaning to it, aiming to draw attention to certain problematic practices still present in the local institutional context. We used semi-structured interviews to collect data. Our approach is qualitative, based on the interpretative phenomenological analysis. The sample consists of 12 transgender people aged 23 to 48 (8 trans men and 4 trans women). Results indicate the great psychological and practical significance of the medical transition, and diversity in their needs when it comes to surgical interventions, implicating the importance of easier access to treatment and the individualization of treatment.
... 78 Socially transitioned transgender pre-pubescent children between 3-12 years have depression and anxiety levels comparable to their cisgender siblings and age-matched peers, suggesting social support throughout transition may reduce negative mental health outcomes. 79 Family-connectedness, teacher support, and feeling safe in one's community protect against negative mental health outcomes among transgender adolescents. 5,80 Receiving gender-affirming hormone therapy decreases depression and suicidality and improves well-being. ...
Christina Huang,1,* Sarah Gold,1,* Rakan Radi,1 Seth Amos,1 Howa Yeung1,2 1Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA; 2Clinical Resource Hub, Veterans Affairs Southeast Network Veterans Integrated Service Network 7, Decatur, GA, USA*These authors contributed equally to this workCorrespondence: Howa Yeung, Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE Suite 100, Atlanta, GA, 30322, USA, Tel +1 (404) 727-9838, Fax +1 (404) 727-5878, Email howa.yeung@emory.eduAbstract: Transgender adolescents seek gender-affirming medical care to address gender identity and incongruence. Improved understanding of the dermatologic impact of gender-affirming medical care such as pubertal suppression, hormone therapy, and surgeries can enhance patient outcome. Pubertal suppression treats dysphoria associated with development of secondary sex characteristics, including androgen-driven acne. Gender-affirming hormone therapy influences acne and hair development in transgender adolescents. Dermatologists can help manage skin effects associated with chest binding and gender-affirming hormone therapy and surgery. Provision of patient-centered gender-affirming care in dermatologic and multidisciplinary settings is essential to improve skin and overall outcomes of gender-affirming therapy.Keywords: gender-affirming care, testosterone, estrogen, acne, anti-androgen
... For children whose gender is different to their sex presumed at birth (hereafter referred to as "trans"), the important, and sometimes precarious role of their parents is being increasingly recognized. It has been demonstrated that family, and in particular, parental support can play a significant protective role for trans children, increasing their resilience and contributing to positive mental health outcomes (Olson et al., 2016;Pariseau et al., 2019;Weinhardt et al., 2019). There is also preliminary evidence to suggest that higher rates of parenting stress predict higher rates of internalizing and externalizing mental health difficulties amongst prepubertal trans children (Kolbuck et al., 2019). ...
Research has shown that parents of trans children face numerous challenges as they navigate their parenting role, however, little is known about the impact of these challenges on parents’ psychological wellbeing. Utilizing an interpretative phenomenological approach and interpretive phenomenological analysis (IPA), the current study aimed to address this gap in the literature by exploring how parents perceive their experience of having a trans child has impacted their psychological wellbeing. Semi-structured in-depth interviews were conducted with Australian parents of trans children aged 17 and under (N = 12). Five major themes were identified in the data: 1) Dyadic factors; 2) Threats to mental health; 3) Personal growth; 4) Support and acceptance; and 5) Coping. Overall, results indicated that experiences of psychological wellbeing were multidimensional, characterized by numerous mental health threats and concurrent positive experiences of personal growth. Findings also highlighted the importance of support and acceptance from others, and various coping strategies employed by parents to protect against mental health threats and enhance their wellbeing. These findings provide an in-depth understanding of factors that both threaten and enhance wellbeing amongst parents of trans children, offering nuanced insight for clinicians and a foundation for future research.
... Importantly, parental acceptance and support of trans youths' gender identity is strongly correlated with protective factors across a range of outcomes. Specifically, trans young people with support experience greater self-esteem, higher quality of life, safer sex practices, lower rates of mental health difficulties such as depression, suicidality and self-harm, and decreased rates of homelessness when compared with trans youth experiencing ambivalent, low or no parental support (Aramburu Alegría, 2018;Durwood et al., 2017;Katz-Wise et al., 2018;Olson et al., 2016;Travers et al. et al., 2012;Wilson et al., 2012). Crucially, research indicates that anything less than strong parental support can have detrimental impacts on trans young people's health and wellbeing (Travers et al., 2012). ...
Trans youth are at high risk of mental health difficulties and negative life events. Strong parental support is highly protective however there is little understanding of what factors facilitate the process of parental understanding and acceptance of a child’s gender identity. We aimed to better understand a) preexisting factors influencing levels of parental acceptance of their child’s gender identity; b) the factors parents find helpful in facilitating acceptance of their child’s gender identity once they become aware; and c) how parents experience extended family, cultural and religious reactions. Using cross-sectional survey data, we explored the experiences of parents and guardians (N = 194). Quantitative data were primarily analyzed using Bayesian regression models and qualitative data were thematically analyzed. Several factors were salient in influencing parental acceptance, including the nature of their child’s gender identity, and levels of awareness and acceptance of the child’s gender identity at time of initial parental awareness. Multiple factors aided acceptance, including information, peer support, and the quality of the dyadic relationship. Findings provide a better understanding of how parental acceptance of a child’s gender identity develops. We provide recommendations on what may help parents to optimally support their child, such as accessible, good-quality information.
We evaluate the association of familial factors and suicidality among transgender adults in the U.S. by estimating the odds of lifetime suicide ideation and attempt using the 2015 U.S. Transgender Survey. Predictors include family support, family rejection, and specific experiences related to both. About 79% of sample respondents have experienced suicidal ideation and nearly 43% have made a suicide attempt. The predicted probability of suicide attempt is 0.35 for those with no family rejection experiences, 0.75 for those who have had all five experiences in our models. Rejection predicts both outcomes and experiences of rejection have a cumulative impact.
Aiemmissa tutkimuksissa on havaittu, että sukupuolivähemmistöön kuuluvat lapset ja nuoret kokevat muita ikäisiään enemmän vanhempien tekemää perheväkivaltaa. Lasten ja nuorten kokeman perheväkivallan ja sukupuolivähemmistöön kuulumisen välistä yhteyttä ei kuitenkaan ole tarkasteltu tarkemmin ja etenkin kotimainen tutkimustieto aiheesta on vähäistä. Tässä artikkelissa tarkastellaan ristiintaulukoinnin ja logistisen regressioanalyysin keinoin translasten ja -nuorten sukupuolivähemmistöön kuulumisen yhteyttä vanhempien tekemään väkivaltaan. Aineistona käytetään vuoden 2022 kansallisen lapsiuhritutkimuksen aineistoa. Tutkimustulosten mukaan translapset ja -nuoret kokevat muita ikäisiään todennäköisemmin vanhempiensa tekemää henkistä ja fyysistä väkivaltaa. Logistisen regressioanalyysin tulosten mukaan yhteys kuitenkin katoaa, kun kontrolloidaan muita perheväkivaltakokemusten todennäköisyyteen vaikuttavia muuttujia. Poikkeuksena on muunsukupuolisten lasten ja nuorten kokema henkinen väkivalta. Muunsukupuolisuuden ja henkisen väkivallan välinen yhteys säilyi tilastollisesti merkitsevänä (OR 1,56, CI 1,11–2,19, p = 0,011) muiden tekijöiden vakioimisenkin jälkeen. Tutkimustulokset antavat viitteitä siitä, että lasten ja nuorten sukupuolivähemmistöön kuulumisen ja vanhempien taholta koetun väkivallan välinen yhteys selittyy pääosin muilla väliin tulevilla tekijöillä. Tulosten perusteella translasten ja -nuorten muita nuoria yleisemmät väkivaltakokemukset näyttäisivätkin johtuvan erilaisten yksilöllisten ja perheeseen liittyvien riskitekijöiden kasautumisesta. Translasten ja -nuorten sekä heidän perheidensä hyvinvointiin ja tarpeisiin tulisikin kiinnittää erityishuomiota ja varmistaa, että sukupuolivähemmistöön kuuluvat alaikäiset ja heidän perheensä saavat riittävää ja asiantuntevaa tukea sekä apua kohtaamiinsa haasteisiin.
Purpose:
The "rapid-onset gender dysphoria" (ROGD) hypothesis theorized, based on a parent-report survey, a distinct and more transient form of gender dysphoria in which individuals purportedly come to understand themselves as transgender and/or gender diverse (TGD) suddenly during adolescence. This study evaluated components of ROGD by (1) estimating the prevalence among TGD adults of first realizing one's TGD identity after childhood (i.e., after the onset of puberty), and (2) assessing the median time between realizing one's gender identity and disclosing this to someone else.
Methods:
We conducted a secondary analysis of the 2015 US Transgender Survey, a survey of 27,715 TGD adults in the United States. Participants were asked the age at which they first realized their gender identity was different than societal expectations based on their sex assigned at birth and grouped by "childhood realization" (ages ≤ 10 years) and "later realization" (ages > 10). They were also asked the age at which they first shared their gender identity with another person.
Results:
Of 27,497 participants, 40.8% reported "later realization" of TGD identities. Within the "childhood realization" group, the median age of sharing one's gender identity with another person was 20. In this group, the median time between realization of one's gender identity and sharing this with another person was 14 years.
Discussion:
A substantial proportion of TGD adults reported realizing their gender identity was different from societal expectations based on their sex assigned at birth during adolescence or later. Several years typically elapsed between participants' TGD identity realization and sharing this with another person. The results of this study do not support the ROGD hypothesis.
Social science is commonly used in debates about controversial issues, especially for those concerning human sexuality. However, caution must be exercised in interpreting such social science literature, because of a variety of methodological and theoretical weaknesses that are not uncommon. Families are complex structurally and over time; such data are not easily analyzed. Merely determining the number of, for example, sexual minority families has been a difficult task. While some new theories are popular with social scientists, for example, sexual minority theory, they are often used to the exclusion of other, equally valid theories and often are not well tested empirically. Some types of families remain relatively unexamined. Social scientists can be biased by their own values, which are reflected in weak use of theory and in a variety of methodological problems. Eight studies are presented as examples of probable confirmation bias, in which methods and theory were modified in unusual ways that may have affected the outcomes and conclusions. Suggestions for improving social science include greater attention to effect sizes rather than statistical significance per se, deliberately minimizing the politicization of science, developing a culture of humility with respect to social science, deliberately reducing common biases, and maintaining a deeper curiosity about social science than is often seen. Scientists must be open to seeing their best “sacred cow” ideas or theories disproven or modified with increases in research on such issues.
Summary
In controversial areas of social science, there can be numerous threats to the validity of science. Here, some of the more common risks for social science research and theory are examined, with several specific illustrations of how bias appears to have crept into social science, often as confirmation bias. Recommendations are made for reducing bias in future research.
One of the first ways some trans youth narrate their gender is through the process of choosing a name. Trans youth’s negotiation of naming is particularly complex as they juggle family affinities and independence, as well as try on new identities and build relationships with peers. In the midst of transitioning, and often while still materially and emotionally dependent on their families, trans youth re-write their birth stories through, in part, the process of choosing a new name. Drawing on in-depth interviews with 10 racially and gender diverse trans youth in Canada, I explore how trans youth choose a name in relation to their family. I analyze these stories using Cavarero’s theory of the formation of the self to think about what the work of names and naming exposes about how trans youth navigate their relationships with their family and their identity development. In their naming practices, trans youth discussed the relationship they have with their family and their negotiation of family reactions to the disclosure of their trans identity. Their narratives about naming and family challenge the binary discourse about family reactions as acceptance or rejection and provide stories about the complex ways trans youth navigate their relationship with their family in their daily lives.
Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths' mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths' health and may constitute key areas for intervention for those supporting them.
Given the growing number of young people presenting to therapy for gender-related concerns, and the growing social awareness of non-binary understandings of gender, it is incumbent upon therapists to improve their own understandings of gender, to gain familiarity with research on gender identity, and to learn to work with clients who present for gender-related concerns. One model of working with transgender, gender nonconforming, and gender questioning adolescents and children, is affirming solutions therapy. This article reviews previously suggested models of therapy for working with gender minorities and discusses the appropriateness of solution-focused brief therapy (SFBT) with affirmative therapy.
Transgender and non-binary (TGNB) individuals often encounter unique and emotionally burdensome challenges related to family planning and reproduction. Though awareness of TGNB-specific healthcare needs is increasing, members of this community still face increased personal, interpersonal, and systemic obstacles compared to their cisgender peers. Medical transition, while often lifesaving, may negatively impact the fertility of those who pursue it. Like many cisgender people, many TGNB people long to be parents, and TGNB people with children often report increased emotional well-being. Like anyone undergoing potentially gonadotoxic treatment, TGNB patients should receive pre-treatment fertility preservation counseling. Those who do not are at risk of future regret, anger, and other negative psychological outcomes, along with decreased options for future family building. Additionally, it is the responsibility of healthcare professionals to create welcoming and affirming clinics for TGNB patients. Providing inclusive paperwork and educational materials, consistently using correct names and pronouns, and situational awareness are integral to this goal.
This research explored experiences of transgender children and their families approaching and into adolescence, understanding experiences relating to puberty and puberty blocking medication. Data were drawn from 30 parents of 30 trans children and adolescents who at time of interview, were an average age of 11 years old. Parental interviewees were 90% white, 93% female, 100% cis, 60% heterosexual. Additional data were drawn from 10 trans children and adolescents, average age 12 years old. Interviews were held remotely, with families from across the UK. Rich qualitative interviews, averaging 2 hours for parents, and 25 minutes for children, covered aspects of family life, healthcare, and education. This article examined a sub-set of data on trans children and adolescents’ experiences of puberty, and of accessing, or trying to access, puberty blockers. Research received ethical approval from the author’s university. Data were analyzed through inductive reflexive thematic analysis. Three major themes are presented, relating to pre-pubertal anxiety; difficulties accessing blockers; and, for a minority who were on blockers, experiences of relief and frustration. The research has significant relevance for families, for healthcare professionals and policymakers, and for all seeking to protect trans adolescent mental health and well-being.
Women are underrepresented in STEM fields across the world. We investigate a perceptual mechanism that may contribute to this gender disparity beginning in early childhood. We explore how visual information about the gender composition of a group of scientists impacts children's persistence on a STEM task and their evaluations of group members. One hundred sixty-six 4- to 6-year-old children viewed one of four groups of scientists: all-male, all-female, a lone female among all-males, or a lone male among all-females. Whereas children's persistence on a STEM task did not change across conditions, their trait judgments did. Children judged the all-male and all-female group scientists as "hardworking," but judged the lone female scientist as "smart." However, they were as likely to judge the lone male scientist as "smart" as to judge him "hardworking." The role of group visualization as a learning mechanism impacting children's perceptions of scientists as early as the preschool years is discussed.
Surgical treatment of gender dysphoria in adolescents is considered a permanent or irreversible intervention. The World Professional Association for Transgender Health provides guidelines that recommend a multidisciplinary approach that includes a mental health provider to support the individual seeking a surgical modification to treat gender dysphoria. Transmasculine individuals may seek chest masculinization surgery before the age of 18 years. In the United States and many countries, genital surgery is delayed until after the age of 18 years when an individual has legal capacity and may consent to the procedure.
This editorial provides a broad introduction to transgender health for transgender and gender-diverse people. Following a brief description of the history of transgender and gender-diverse people, the development of medical treatment is discussed, together with the use of appropriate terminology and language. The content largely draws attention to the guidance in the Standards of Care for the Health of Transgender and Gender Diverse People Version 8 developed by the World Professional Association for Transgender Health (WPATH) and published in 2022. Further key areas addressed are as follows. • The use of names and pronouns. • Population estimates of transgender and gender diverse people. • Diagnostic classification systems in transgender health. • A wide range of gender-affirming medical interventions, including hormones and surgeries. • Ethical considerations for research with transgender and gender diverse populations.
Purpose:
Transgender adolescents (TGAs) have high risk for experiencing mental health problems, but little is known about how aspects of gender identity relate to their mental health symptoms. Evidence from child and adult samples of transgender individuals indicates making progress in gender transition milestones and higher levels of congruence between gender identity and gender expression are related to fewer mental health problems. We examined associations between perceived transition progress, gender congruence, and mental health symptoms in a diverse, nationwide sample of TGAs.
Methods:
TGAs (n = 1,943) participated in a cross-sectional online survey. Perceived gender transition progress, gender congruence, and depressive and anxiety symptoms were assessed. Path analysis was conducted to examine whether transition progress was related to mental health symptoms via higher levels of gender congruence.
Results:
Most TGAs had undertaken at least one social transition step (98%), but only 11% had taken medical transition steps. Higher gender congruence was associated with lower mental health symptoms. Greater transition progress was associated with higher gender congruence, and perceived transition progress evidenced negative indirect associations with mental health symptoms. TGAs identifying with binary identities (transmasculine and transfeminine youth) reported lower levels of transition progress and gender congruence compared to other subgroups of TGAs.
Discussion:
Higher levels of perceived transition progress and gender congruence are related to lower mental health symptoms among TGAs. Mental health interventions tailored to the unique developmental needs of TGAs are needed given high risk for mental health problems within this population, and interventions addressing transition progress and gender congruence should be examined.
Depuis la création de consultations dédiées en 2014, les enfants et adolescent(e)s transgenres peuvent être accompagnés en France par des équipes pluridisciplinaires. L’accompagnement personnalisé qui s’y est développé s’appuie sur des recommandations internationales, reposant elles-mêmes sur des études scientifiques qui ont démontré l’impact bénéfique d’un tel accompagnement à court et moyen termes. De nombreuses questions persistent néanmoins, à la fois médicales, en particulier sur les effets à long terme des traitements ou l’impact sur la fertilité, mais aussi éthiques. L’accumulation de données au long cours permettra d’apporter à ces jeunes et à leur famille les informations les plus éclairées possibles.
Transgender conversion practices involve attempts to alter, discourage, or suppress a person’s gender identity and/or desired gender presentation, including by delaying or preventing gender transition. Proponents of the practices have argued that they should be allowed until proven to be harmful. Drawing on the notion of expressive equality, I argue that conversion practices are prima facie unethical because they do not fulfill a legitimate clinical purpose and conflict with the self-understanding of trans communities.
The number of adolescents who present themselves to the healthcare system due to the aspect of trans* is rising internationally as well as nationally. Studies, especially from the international area, point next to appropriate treatment situations increasingly to aversively experienced situations.These are characterized by lack of knowledge of the professionals, incorrect naming and pronoun naming as well as inappropriate questions and comments. In order to shed light on the situation in Germany, semi-structured interviews were conducted with ten adolescents and evaluated using qualitative content analysis. Overall, a balanced ratio of positive, appropriate and negative, aversive experiences emerged. Themes were gender-sensitive language, ways of interacting, support/networking and knowledge. The adolescents named parental support and connection to self-help groups as supportive instances in dealing with the healthcare system, but also mentioned structural hurdles such as long waiting times. Overall, the adolescents had a positive outlook on the future and would like to see a sensitization of healthcare workers. Educationalmeasures and further training should be implemented in order to meet these wishes and to ensure needs-based care for trans* adolescents.
Significance. Gender incongruence (GI) is a poorly covered problem of the domestic healthcare. It is characterized by a distinct and persistent incongruence between gender identity of a person and gender assigned at birth. This incongruence sometimes manifests in suicidal mood and autoaggression. Purpose: To analyse mental health and suicide rates among persons with GI in the Russian population in connection with the age at which they received information about transgenderism. Material and methods: a retrospective analysis of patient records who applied for gender-affirmative care. Results: Transgender people go through a long way of realizing themselves and their problems. On average, the period from the onset of the first symptoms of GI to the time of seeking gender-affirmative care equals to more than 10 years. In the group of transgender patients, 75.2% do not have any mental disorders. However, a rather high prevalence of comorbid mental pathology (24.8%) was observed. These are generally background mental disorders and reversible mental disorders that are not the cause of GI. Frequency of suicides in the group of transgender people equals to 12.8%. On average, there are 1.3 suicide attempts (1 - 5) per patient with a suicidal experience. The frequency of suicidal activity and the burden of comorbid diseases are higher in the group with children. This group also shows a later age of obtaining information. A relationship between suicidal activity, depression, auto-aggressive behaviour, incidence and severity of comorbid mental pathology and the age at which the patient was informed about transgenderism and therefore, realized their problem has been identified. Transgender patients with the onset of gender dysphoria at puberty are most vulnerable to developing a mental pathology. A negative impact on mental health and suicidal behaviour has been demonstrated in individuals attempted to adapt to the gender registered in the passport and were forced to perform the role opposite to their gender identity. Conclusion: Timely awareness of parents and adolescents about GI is an important modifiable factor for reducing the incidence of suicide and preventing the development of comorbid mental disorder in individuals with GI. An earlier possibility of adequate information about the state, possibilities for solving problems, preventing pressure from the family, teachers and society will improve mental health in GI population and reduce social loss.
Résumé
Ces dernières années, la communauté médicale est traversée par les débats sociétaux autour du genre, du sexe, de la procréation et des droits humains. Aussi les questions autour de la prise en charge médicale des enfants et adolescents transgenres viennent elles très régulièrement sur le devant de la scène médiatique suscitant la mobilisation de collègues à l’origine de prise de positions réclamant entre autres l’interdiction de prescrire des traitements hormonaux jusqu’à 25 ans. Nous proposons dans cet article de reprendre point par point les principaux sujets de controverses autour de la prise en charge médicale contemporaine des transidentités de l’enfant et de l’adolescent, à savoir la transition sociale, le blocage pubertaire, les transitions hormonales, et les transitions chirurgicales, et de les mettre en perspective de la situation contemporaine en France. Si la plupart des études cliniques menées depuis plus de 25 ans montrent les impacts positifs des prises en charge médicales des adolescents transgenres sur leur devenir psychologique soulignant l’innocuité relative des traitements, l’accompagnement psychodynamique n’en demeure pas moins essentiel, prenant en compte la singularité de chaque patient au fil des rencontres. Le temps long est parfois requis, parfois contre-indiqué en fonction de chaque situation clinique. Rappelons qu’il n’y a aucune prescription médicamenteuse avant la puberté, et pour les adolescents la durée moyenne entre la première consultation (pour laquelle ils ont attendu souvent un an) et une éventuelle prescription est d’une année. Dans le contexte où la population des enfants et adolescents transgenres est particulièrement vulnérable, ne pas nuire n’est pas systématiquement s’abstenir de prescrire, chaque situation clinique devant être évaluée dans sa singularité avec précaution et discernement. Ces décisions de transition médicale sont discutées et validées si pertinentes, en France depuis 2015, dans le cadre de Réunions de Concertation Pluridisciplinaire. Par-delà les opinions et les débats sociétaux, de réels enjeux éthiques sont à considérer, en particulier autour de la notion de consentement libre et éclairé chez l’enfant et l’adolescent, et les recherches doivent se poursuivre.
Fundamentally, queer theory is defined by the use of the word “queer” as a noun, an adjective, and a verb. Something or someone is queer if they are not-normative (adj.); quare adds the nuance of uncontainable, excessive, or overflowing to non-normativity (Johnson, 2001). A person may use the identity label queer (noun) to indicate a way of being different, often but not exclusively in the realm of sexuality and gender. Finally, queering, the verb, is used to deconstruct that which is normative or the concept of normativity altogether.
One of the most significant protective factors for transgender youth is caregiver support, but caregivers often struggle with accepting their child’s gender identity. Many of these caregivers experience ambiguous loss, grieving the gendered aspects of their child and of the caregiver-child relationship. However, disenfranchised grief often goes unrecognized by the caregiver, and/or unsupported by society, and can also be difficult to reconcile with the caregiver’s love for their child. Thus, the following article details the nature of disenfranchised grief and ambiguous loss and describes how counselors must be prepared to normalize this grief, while helping caregivers of transgender youth mourn their loss and create meaning from the adversity, in part by reframing this loss as positive change since it will enhance the emotional and physical well-being of the child. Counselors also provide resources and referrals, debunk common myths about transgender identities, and help caregivers explore their emotions while navigating their grief through personal therapy, relationship counseling, and support groups specifically designed for caregivers of transgender youth.
The aim of this study was to examine concordance and discordance in how different family members in families with transgender or nonbinary (TNB) youth described topics related to the TNB youth’s gender identity and its effects on the family. TNB youth, ages 7–18 years, and their caregivers (54 family members: 20 TNB youth, 34 caregivers) participated in one-on-one qualitative interviews. Interview transcripts were analyzed to determine concordance/discordance in family members’ responses (between TNB youth and each caregiver, between caregivers in two-caregiver families, and among all three family members) to 13 different interview questions. Results indicated the highest concordance was found between family members regarding how the youth’s gender identity affected family relationships. The highest discordance was found in family member’s descriptions of the TNB youth’s gender expression and future expectations for the TNB youth. Findings from this study have implications for supporting families with TNB youth.
Objective : to identify potentially reversible clinical and socio-demographic factors influencing the social adaptation of patients with gender incongruence (GI). Materials and methods : a retrospective analysis of 926 patient records with MtF and FtM GI was performed. Results : among the patients who applied, 44.38% were MtF, 55.62% were FtM. The mean age was 24.0 years (from 13 to 65 years). The educational level of patients is mainly represented by higher (44.2%) and specialized (22.3%) education, 43% of persons lived in the village, 57% - in urban areas. The majority of those who applied grew up in a complete family (82.02%). The first manifestations of GI started mainly in the prepubertal (26.4%) and parapubertal (61.6%) period (up to 13 years). The average age of accepting oneself as a transgender person was 17.0 years. Steps to reduce dysphoria and receive specialized care are usually taken after the age of 20. 83.1% of transgender patients had depressive episodes, and a third (38.5%) had autoaggression. Additional psychiatric diagnoses were present in 24.5% of patients and are represented by 3 groups of diseases: group 1 (6.2%) — potentially reversible neurotic disorders; group 2 (14.1%) — background mental illnesses that are not the cause of GI; group 3 (4.3%) — other mental states with “ideas of sex change”. Conclusions : improvement of social adaptation and prevention of emotional and psychological experiences in persons with GI, assistance is possible at several levels: family, educational institutions, medical community, patient organizations.
Working with lesbian, gay, bisexual transgender, and queer-identified (LGBTQ) youth can present a uniquely challenging opportunity for clinicians given the rapidly changing landscapes of gender and sexuality and deficits in training and education. The goal of this article is to provide the most up-to-date trends and advances in the mental health care of LGBTQ youth to empower clinicians in delivering evidence-based care. We adapt the "Spheres of Influence" model to challenge the clinician to think more globally about our interventions. When LGBTQ youth are supported at every sphere, we give them the best chance to survive and thrive into adulthood.
Across Europe, Canada, and the United States, 22-43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact.
The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks.
Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10(th) versus 90(th) percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10(th) percentile.
Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
The present study represents findings from interviews with five mothers, each of whom had a transgender child. All of the transgender children were natal/biological males between the ages of 8 and 11 years old and had socially transitioned to living as girls. Ehrensaft's (2012) notion of the “true gender self” was integrated with an ecological perspective to examine multiple interacting contexts, including family, neighborhood, and school, in which the participants lived. An overarching theme of “transformation” (or lack thereof) was used to organize the findings in relation to the transgender children, their families, and their communities. Changes in relation to the children's demeanor and well-being before and after their social transitions (e.g., from shy and depressed to happy and well-adjusted), the parents’ and other family members’ feelings and reactions to the children's gender identities and expressions over time (e.g., health care professionals and school staff learning along with and from the families), and the responses of others in the community (e.g., lack of knowledgeable health care professionals and school personnel) are discussed. Findings have implications for practice and future research.
Family support is protective against health risks in sexual minority individuals. However, few studies have focused specifically on transgender youth, who often experience rejection, marginalization, and victimization that place them at risk for poor mental health. This study investigated the relationships among parental support, quality of life, and depression in transgender adolescents.
A total of 66 transgender youth presenting for care at Children's Hospital Los Angeles completed a survey assessing parental support (defined as help, advice, and confidante support), quality of life, and depression. Regression analyses assessed the associations between parental support and mental health outcomes.
Parental support was significantly associated with higher life satisfaction, lower perceived burden of being transgender, and fewer depressive symptoms.
Parental support is associated with higher quality of life and is protective against depression in transgender adolescents. Interventions that promote parental support may significantly affect the mental health of transgender youth.
The recent film Boys Don't Cry illustrates in a highly dramatised form the problems that the phenomenon of gender identity disorder can create in an extreme situation. The film is based on the true story of a young person, Brandon, with a female body who perceived himself as a male. In the film we do not know when the issue of his male gender identity first appeared, but we see him living in a male role as a teenager trying to conceal, to his peers, the reality of his female body. (I refer to Brandon as ‘he’ because this is how Brandon presents himself in the film. The dilemma about using ‘he’ or ‘she’ typically confronts professionals in the management of teenagers like Brandon.) The struggles of these concealments are well portrayed, as in the scene when he steals tampons from a shop. He joins in male activities and displays of physical strength as a confirmation of his male role. He is well accepted as a boy within a troubled and troublesome group of young people. He falls passionately in love with a girl, Lana, who accepts him as he is without much questioning, and a close intimate relationship develops, which the peer group seems to accept. The reality of his body is eventually revealed. His girlfriend can accept the new situation, but had she really not known or had she turned a blind eye? Unfortunately, two young men become more and more disturbed by this realisation. It stirs a primitive violence in them, which leads first to Brandon's rape and then to his murder.
The authors investigated the emergence of gender differences in clinical depression and the overall development of depression from preadolescence to young adulthood among members of a complete birth cohort using a prospective longitudinal approach with structured diagnostic interviews administered 5 times over the course of 10 years. Small gender differences in depression (females greater than males) first began to emerge between the ages of 13 and 15. However, the greatest increase in this gender difference occurred between ages 15 and 18. Depression rates and accompanying gender differences for a university student subsample were no different than for a nonuniversity subsample. There was no gender difference for depression recurrence or for depression symptom severity. The peak increase in both overall rates of depression and new cases of depression occurred between the ages of 15 and 18. Results suggest that middle-to-late adolescence (ages 15–18) may be a critical time for studying vulnerability to depression because of the higher depression rates and the greater risk for depression onset and dramatic increase in gender differences in depression during this period.
Objectives:
We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population.
Methods:
In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Guided by the minority stress model, we evaluated associations between stigma and mental health and tested whether indicators of resilience (family support, peer support, identity pride) moderated these associations.
Results:
Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. We found few differences by gender identity.
Conclusions:
Our findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.
We examined the frequency and predictors of suicide attempts among gender minority individuals (N = 153) who were recruited at a transgender conference. Eighteen percent of the participants reported a past suicide attempt, with trans men reporting the highest rate of suicide attempts (41%), followed by trans women (20%). Factors associated with having a past suicide attempt included female sex assigned at birth, psychiatric hospitalisations, and having experienced transgender-related violence. Implications of these data are considered in the context of intervention development for this at-risk group.
In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially
from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families,
schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such
children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included
attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize,
viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social
worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization
is the path they would prefer.
This article provides a summary of the therapeutic model and approach used in the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto. The authors describe their assessment protocol, describe their current multifactorial case formulation model, including a strong emphasis on developmental factors, and provide clinical examples of how the model is used in the treatment.
Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population.
This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth.
A community sample of 246 LGBT youth (aged 16-20 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011.
A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (p<0.01); sensation-seeking (p=0.04); female gender (p<0.01); childhood gender nonconformity (p<0.01); and prospective hopelessness (p<0.01) and victimization (p<0.01) were associated with greater self-harm.
General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.
Internalizing psychopathology, anxiety in particular, is assumed to contribute to the development of gender Identity disorder (GID). Until now, anxiety has only been reported in studies using parent-report questionnaires; physiological correlates of anxiety have not been studied. In this study we assessed anxiety and stress in children with GID by measuring their cortisol, heart rate (HR) and skin conductance levels (SCL) and asking them to repeat their moods and experience of control.
By using an established psychological challenge, involving provocation and frustration, we investigated whether children with GID as compared to healthy controls react in a more anxious way under these experimental circumstances. We assessed anxiety levels in 25 children with GID and 25 matched controls by measuring cortisol, HR and skin conductance and examined whether a pattern of increased physiological activity corresponded with the feeling of being less in control and having more intense negative emotions.
The results showed that children with GID had more negative emotions and a tonically elevated SCL. There were no differences between the groups in cortisol and HR.
This is the first study that shows that children with GID have a more anxious nature as compared to their normal counterparts.
Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.
This is a report on parents who have children who exhibit gender variant behaviors and who contacted an affirmative program in the United States for assistance. All parents completed the Child Behavior Checklist, the Gender Identity Questionnaire, and the Genderism and Transphobia Scale, as well as telephone interviews. The parents reported comparatively low levels of genderism and transphobia. When compared to children at other gender identity clinics in Canada and The Netherlands, parents rated their children's gender variance as no less extreme, but their children were overall less pathological. Indeed, none of the measures in this study could predict parents' ratings of their child's pathology. These findings support the contention that this affirmative program served children who were no less gender variant than in other programs, but they were overall less distressed.
Because of the stigma associated with transgenderism, many transwomen (biological males who identify as female or transgender) experience rejection or abuse at the hands of their parents and primary caregivers as children and adolescents. The Parental Acceptance-Rejection (PAR) theory indicates that a child's experience of rejection may have a significant impact on their adult lives. The purpose of this study was to conduct a qualitative analysis of adult transwomen of color's experiences with caregivers, guided by PAR theory. Twenty transwomen of color completed semi-structured interviews exploring the reaction of their parents and primary caregivers to their gender. While many participants reported that at least one parent or close family member responded with warmth and acceptance, the majority confronted hostility and aggression; reports of neglect and undifferentiated rejection were also common. Many transwomen were forced out of their homes as adolescents or chose to leave, increasing their risk of homelessness, poverty, and associated negative sequelae. Future research is needed to explore how families come to terms with having a transgender child and how best to promote acceptance of such children.
Peer victimization experiences represent developmentally salient stressors among adolescents and are associated with the development of internalizing symptoms. However, the mechanisms linking peer victimization to adolescent psychopathology remain inadequately understood. This study examined emotion dysregulation as a mechanism linking peer stress to changes in internalizing symptoms among adolescents in a longitudinal design. Peer victimization was assessed with the Revised Peer Experiences Questionnaire (M. J. Prinstein, J. Boergers, & E. M. Vernberg, 2001) in a large (N = 1,065), racially diverse (86.6% non-White) sample of adolescents 11-14 years of age. Emotion dysregulation and symptoms of depression and anxiety were also assessed. Structural equation modeling was used to create a latent construct of emotion dysregulation from measures of discrete emotion processes and of peer victimization and internalizing symptoms. Peer victimization was associated with increased emotion dysregulation over a 4-month period. Increases in emotion dysregulation mediated the relationship between relational and reputational, but not overt, victimization and changes in internalizing symptoms over a 7-month period. Evidence for a reciprocal relationship between internalizing symptoms and relational victimization was found, but emotion dysregulation did not mediate this relationship. The implications for preventive interventions are discussed.
The current research provides a framework for understanding how concealable stigmatized identities impact people's psychological well-being and health. The authors hypothesize that increased anticipated stigma, greater centrality of the stigmatized identity to the self, increased salience of the identity, and possession of a stigma that is more strongly culturally devalued all predict heightened psychological distress. In Study 1, the hypotheses were supported with a sample of 300 participants who possessed 13 different concealable stigmatized identities. Analyses comparing people with an associative stigma to those with a personal stigma showed that people with an associative stigma report less distress and that this difference is fully mediated by decreased anticipated stigma, centrality, and salience. Study 2 sought to replicate the findings of Study 1 with a sample of 235 participants possessing concealable stigmatized identities and to extend the model to predicting health outcomes. Structural equation modeling showed that anticipated stigma and cultural stigma were directly related to self-reported health outcomes. Discussion centers on understanding the implications of intraindividual processes (anticipated stigma, identity centrality, and identity salience) and an external process (cultural devaluation of stigmatized identities) for mental and physical health among people living with a concealable stigmatized identity.
The authors evaluated emotional distress among 9th-12th grade students, and examined whether the association between being lesbian, gay, bisexual, and/or transgendered (i.e., "LGBT") and emotional distress was mediated by perceptions of having been treated badly or discriminated against because others thought they were gay or lesbian. Data come from a school-based survey in Boston, Massachusetts (n = 1,032); 10% were LGBT, 58% were female, and ages ranged from 13 to 19 years. About 45% were Black, 31% were Hispanic, and 14% were White. LGBT youth scored significantly higher on the scale of depressive symptomatology. They were also more likely than heterosexual, non-transgendered youth to report suicidal ideation (30% vs. 6%, p < 0.0001) and self-harm (21% vs. 6%, p < 0.0001). Mediation analyses showed that perceived discrimination accounted for increased depressive symptomatology among LGBT males and females, and accounted for an elevated risk of self-harm and suicidal ideation among LGBT males. Perceived discrimination is a likely contributor to emotional distress among LGBT youth.
This article provides a selected overview of the literature on gender identity disorder and psychosexual problems in children and adolescents, with a focus on diagnosis, clinical course, etiology, and treatment.
Cross-sectional quantitative designs are often used to investigate whether peer victimization is positively related to psychosocial maladjustment. This paper presents a meta-analytic review of cross-sectional studies, published between 1978 and 1997, of the association of peer victimization with psychosocial maladjustment. Mean effect sizes were calculated for the association between peer victimization and each form of maladjustment (depression, loneliness, generalized and social anxiety, and global and social self-worth) assessed. The results suggested that victimization is most strongly related to depression, and least strongly related to anxiety. There was no evidence that victimization is more strongly related to social than to psychological forms of maladjustment. Effect sizes were stronger when the same informants were used to assess both victimization and maladjustment than when different informants were used. There were some design limitations to the studies reviewed, but all together their results provide a strong background for more complex research into the course and treatment of victims' distress.
The heritability and prevalence of the gender identity disorder (GID) was examined, as well as its comorbidity with separation anxiety and depression, in a nonretrospective study of child and adolescent twins. The parents of 314 twins (ages 4-17 years; 96 monozygotic pairs [MZ] and 61 dizygotic [DZ] pairs) completed the Coolidge Personality and Neuropsychological Inventory (CPNI) containing a six-item DSM-IV-based GID scale. Prevalence of clinically significant GID symptomatology in the twin sample was estimated to be 2.3%. Univariate model fitting analyses were conducted using an ordinal transformation of the GID scale. The model that best described the data included a significant additive genetic component accounting for 62% of the variance and a nonshared environmental component accounting for the remaining 38% of the variance. Results suggested no heterogeneity in the parameter estimates resulting from age. The correlation between GID and depression was modest, but significant (r = .20; P < .05), whereas the correlation between GID and separation anxiety was nonsignificant (P > .05). Overall, the results support the hypothesis that there is a strong heritable component to GID. The findings may also imply that gender identity may be much less a matter of choice and much more a matter of biology.
This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study-the first cross-national, cross-clinic comparative analysis of children with gender identity disorder-found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.
Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.
High prevalences of depression have been reported in male-to-female (MTF) transgender communities. We explored factors associated with depressive symptomatology among MTF spectrum trans people in Ontario, using data from the Trans PULSE Project Phase II respondent-driven sampling survey (n = 433 participants, including 191 MTFs with data needed for this analysis). We estimated the prevalence of depression at 61.2%. Factors associated with higher odds of depressive symptomatology included living outside of Toronto, having some college or university (vs. completed), being unemployed, and experiencing higher levels of transphobia. Increasing social support was associated with reduced odds of depressive symptomatology. Multivariable analyses suggested complex relationships between these factors, passing, and childhood abuse, which require additional study.
The aim of the present study was to evaluate the presence of psychiatric diseases/symptoms in transsexual patients and to compare psychiatric distress related to the hormonal intervention in a one year follow-up assessment. We investigated 118 patients before starting the hormonal therapy and after about 12 months. We used the SCID-I to determine major mental disorders and functional impairment. We used the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS) for evaluating self-reported anxiety and depression. We used the Symptom Checklist 90-R (SCL-90-R) for assessing self-reported global psychological symptoms. Seventeen patients (14%) had a DSM-IV-TR axis I psychiatric comorbidity. At enrollment the mean SAS score was above the normal range. The mean SDS and SCL-90-R scores were on the normal range except for SCL-90-R anxiety subscale. When treated, patients reported lower SAS, SDS and SCL-90-R scores, with statistically significant differences. Psychiatric distress and functional impairment were present in a significantly higher percentage of patients before starting the hormonal treatment than after 12 months (50% vs. 17% for anxiety; 42% vs. 23% for depression; 24% vs. 11% for psychological symptoms; 23% vs. 10% for functional impairment). The results revealed that the majority of transsexual patients have no psychiatric comorbidity, suggesting that transsexualism is not necessarily associated with severe comorbid psychiatric findings. The condition, however, seemed to be associated with subthreshold anxiety/depression, psychological symptoms and functional impairment. Moreover, treated patients reported less psychiatric distress. Therefore, hormonal treatment seemed to have a positive effect on transsexual patients’ mental health.
A distinction is made between two different but closely related syndromes—“cross gender identification” and “gender behavior disturbance”—in male children. Based on assessment data and systematic clinical observations of a group of 47 such children in a longitudinal research study, a set of factors are identified as relevant to the diagnostic task. Specific diagnostic procedures were developed for the clinical evaluation and psychological testing of male children referred for potential gender dysphoric problems, and these procedures are presented in detail with accompanying rationale.
Objective:
The purpose of the current study was to examine facilitative and avoidant coping as mediators between distress and transition status, social support, and loss.
Method:
A total of 351 transgender individuals (n = 226 transgender women and n = 125 transgender men) participated in this study. Participants completed measures on transgender identity, family history of mental health concerns, perceptions of loss, coping, depression, and anxiety.
Results:
The rates of depressive symptoms (51.4% for transgender women; 48.3% for transgender men) and anxiety (40.4% for transgender women; 47.5% for transgender men) within the current study far surpass the rates of those for the general population. Structural equation modeling (SEM) was used to analyze the data-2 separate models were hypothesized, based on reports of anxiety or depression. The SEM results suggest that the processes for transgender women and transgender men are primarily similar for depression and anxiety; avoidant coping served as a mediator between transition status and both distress variables. Social support was directly related to distress variables, as well as indirectly related through avoidant coping.
Conclusion:
Results suggest the need for practitioners to focus on interventions that reduce avoidant coping strategies, while simultaneously increasing social support, in order to improve mental health for transgender individuals. Individuals who are in the beginning stages of their transition will use different coping strategies than those who are in later stages; interventions should be adjusted on the basis of the transition status of transgender clients.
This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.
Mixed-race individuals often encounter situations in which their identities are a source of tension, particularly when expressions of multiracial and biracial identity are not supported or allowed. Two studies examined the consequences of this identity denial. In Study 1, mixed-race participants reported that their biracial or multiracial identity caused tension in a variety of contexts. Study 2 focused on one often-mentioned situation: completing a demographic questionnaire in which only one racial background can be specified. Relative to mixed-race participants who were permitted to choose multiple races, those compelled to choose only one showed lower subsequent motivation and self-esteem. These studies demonstrate the negative consequences of constraining mixed-race individuals’ expression of their chosen racial identity. Policy implications for the collection of racial and ethnic demographic data are discussed.
The objective of the present study is to describe the item response theory (IRT) analysis of the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS(®)) pediatric parent proxy-report item banks and the measurement properties of the new PROMIS(®) Parent Proxy Report Scales for ages 8-17 years.
Parent proxy-report items were written to parallel the pediatric self-report items. Test forms containing the items were completed by 1,548 parent-child pairs. CCFA and IRT analyses of scale dimensionality and item local dependence, and IRT analyses of differential item functioning were conducted.
Parent proxy-report item banks were developed and IRT parameters are provided. The recommended unidimensional short forms for the PROMIS(®) Parent Proxy Report Scales are item sets that are subsets of the pediatric self-report short forms, setting aside items for which parent responses exhibit local dependence. Parent proxy-report demonstrated moderate to low agreement with pediatric self-report.
The study provides initial calibrations of the PROMIS(®) parent proxy-report item banks and the creation of the PROMIS(®) Parent Proxy-Report Scales. It is anticipated that these new scales will have application for pediatric populations in which pediatric self-report is not feasible.
In this study, we tried to clarify the prevalence of suicidal ideation and self-mutilation including suicide attempts among patients with gender identity disorder (GID) and the relationship of those behaviors to demographic characteristics. A total of 500 consecutive Japanese GID patients without any other psychiatric comorbidity were evaluated at the outpatient GID Clinic of Okayama University Hospital. The lifetime rate of suicidal ideation was 72.0% of the total sample. There were no significant differences in the prevalence of suicidal ideation among groups divided by sex, age, age at onset or education. The lifetime prevalence of self-mutilation including suicide attempts was 31.8% of the total sample. Low level of education was significantly related to self-mutilation among both male-to-female and female-to-male GID patients. Younger age at onset was a significant factor affecting self-mutilation only among MTF GID patients. A lack of strategies to cope with severe distress among persons with lower education might induce a high frequency of self-mutilation including suicidal attempt. GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation.
Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior.
The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non-Latino White respondents. A 10-item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self-esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self-reported HIV risk.
Lesbian, gay, bisexual, and transgender-related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization.
Reducing LGBT-related school victimization will likely result in significant long-term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities.
the role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established.
a quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N= 245).
family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors.
family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.
Hour-to-hour emotional states reported by children, ages 9-15, were examined in order to evaluate the hypothesis that the onset of adolescence is associated with increased emotional variability. These youths carried electronic pagers for 1 week and filled out reports on their emotional states in response to signals received at random times. To evaluate possible age-related response sets, a subset of children was asked to use the same scales to rate the emotions shown in drawings of 6 faces. The expected relation between daily emotional variability and age was not found among the boys and was small among the girls. There was, however, a linear relation between age and average mood states, with the older participants reporting more dysphoric average states, especially more mildly negative states. An absence of age difference in the ratings of the faces indicated that this relation could not be attributed to age differences in response set. Thus, these findings provide little support for the hypothesis that the onset of adolescence is associated with increased emotionality but indicate significant alterations in everyday experience associated with this age period.
Twenty-five extremely feminine boys with DSM-III diagnosis of gender identity disorder of childhood were evaluated for the presence of behavioral disturbances, social competence and separation anxiety. Using the Child Behavior Checklist created by Achenbach and Edelbrock in 1983, 84% of feminine boys were reported to display behavioral disturbances usually seen in clinic-referred children. Sixty-four percent of the sample had difficulties with peers that were comparable to those of psychiatric-referred boys. Sixty percent of the sample met the criteria for diagnosis of DSM-III separation anxiety disorder. Only one child in sample fell within the normal range on all three of these parameters. Results suggest extreme boyhood femininity is not an isolated finding, but part of a more pervasive psychological disturbance. Additional clinical findings support this contentione.