“Rapid onset gender dysphoria”: What a hoax diagnosis looks like

The concept of “rapid onset gender dysphoria” was proposed in July of 2016 by a trio of blogs with a history of overtly transphobic perspectives that are at odds with the current evidence on transness: 4thwavenow.com, transgendertrend.com, and youthtranscriticalprofessionals.org. This “diagnosis” is intended to describe an alleged phenomenon of trans men who abruptly begin to experience gender dysphoria in adolescence, having supposedly been influenced by learning about transgender topics on social media. It is invariably described as a “social contagion”. The site “Parents of ROGD Kids” provides a representative example of how this diagnosis is depicted by its advocates:

We are a group of parents whose children have suddenly—seemingly out of the blue—decided they identify strongly with the opposite sex and are at various stages in transitioning.  This is a new phenomenon that has only recently been identified.  Researchers are calling it Rapid-Onset Gender Dysphoria (ROGD), and it is epidemic among our most vulnerable youth.

Our children are young, naïve and impressionable, many of them are experiencing emotional or social difficulties.  They are strongly influenced by their peers and by the media, who are promoting the transgender lifestyle as popular, desirable and the solution to all of their problems.  And they are being misled by authority figures, such as teachers, doctors and counselors, who rush to “affirm” their chosen gender without ever questioning why.

One of the most obvious questions about this supposed phenomenon is how, over more than 50 years of research into just about every aspect of gender dysphoria, the existence of a wholly distinct form of dysphoria could have been completely overlooked. And if, as many advocates of this diagnosis claim, this is a newly emergent phenomenon that has only appeared over the past several years, what clinical features have been identified to distinguish this from the traditional form of dysphoria?

Gender dysphoria in youth is an area of intensive study, and we might expect a great deal of research to be conducted on any apparently new form of gender dysphoria that has suddenly appeared. However, there are few satisfying answers to these questions in published literature. The polite way to describe this would be “very low quality evidence”, but no-quality evidence is more accurate. At the present time, the published research into “rapid onset gender dysphoria” consists entirely of one 2017 poster abstract of an online survey of 164 parents (Littman, 2017), sourced from the aforementioned trio of transphobic blogs: 4thwavenow.com, transgendertrend.com, and youthtranscriticalprofessionals.org. This alone biases the results to the point that they are of very little value.

By focusing entirely on parent reports, the study wholly omits any information that could be provided by their children. This is a crucial gap: these children have not been administered any validated survey instruments on gender dysphoria, mental health, social functioning, or anything that would serve to demarcate this “new” condition from the traditional form of gender dysphoria currently observed among youth. Parent reports of a “rapid” onset of dysphoria are especially questionable: many trans youth understandably conceal their identities for years, knowing the consequences of coming out to potentially unaccepting parents could be dire (American Psychiatric Association, 2013). What appears to a parent to be a “rapid” onset may not have been rapid for their child at all, and it is common in trans support forums to hear from youth (and adults) whose parents protest that they “never showed any signs”. The existing evidence on “rapid onset gender dysphoria” does not distinguish between these possibilities at all.

The poster abstract further claims that “On average, 3.5 friends per group became gender dysphoric.” This implies that not only do these parent respondents have fully accurate knowledge of their own child’s gender identity development, but also that they have accurately identified this “rapid onset” in other people’s children as well. Littman is assuming the truth of her own conclusion here. There is no reason to believe this is reliable, and no evidence is presented to support the claim that these other children became gender dysphoric rather than revealing a previously unexpressed gender dysphoria that was already present. The study itself is still unpublished.

Other literature making reference to this phenomenon is similarly long on speculation but short on evidence. Zucker (2017) cites Littman and inaccurately describes the poster abstract as “preliminary clinical findings” rather than an anonymous online survey subject to severe sampling bias. Lisa Marchiano, a Jungian psychoanalyst, claims without evidence that “rapid onset gender dysphoria” is “a new presentation of a condition that has not been well studied”, on the basis of her “fear” that “adopting a transgender identity has become the newest way for teen girls to express feelings of discomfort with their bodies” (Marchiano, 2017). Once again, no clinical findings are presented to distinguish this from the existing construct of gender dysphoria, which also typically involves an expression of feelings of discomfort with one’s body (APA, 2013).

Ray Blanchard and J. Michael Bailey, who would normally publish their research on sexology topics in peer-reviewed journals, have instead posted a summary of the alleged phenomenon of rapid onset gender dysphoria on 4thwavenow.com, citing unnamed clinicians they’ve “been in touch with”. In the absence of clinical evidence that would clarify even the most rudimentary aspects of this supposed condition, their assertion that “ROGD can only make things worse, both for the affected person and her family” is entirely unsupported.

Debra Soh, a neuroscientist, claims in The Globe and Mail that clinicians should not “treat all cases of gender dysphoria the same way”. However, rather than explaining how treatment approaches should differ for allegedly distinct forms of gender dysphoria, Soh simply states that “These girls frequently also have other mental-health conditions, like autism or borderline personality disorder, that should be the focus of concern instead.” The comorbidity of autism or mental health issues with gender dysphoria has been well-recognized in literature for many decades (Strang et al., 2018; Heylens et al., 2014), and the presence of autism or co-occurring mental health conditions does not indicate that a person is not gender dysphoric (Byne et al, 2012). Comorbidity does not mean mutual exclusivity – it is the exact opposite of that.

This total absence of a clear clinical picture has not deterred numerous politically conservative and religious sources from misleadingly presenting “rapid onset gender dysphoria” as an established phenomenon rather than a questionable construct based on poor science of ideologically biased origin. These include LifeSite, Barbara Kay, the Catholic Institute for Marital Healing, the Minnesota Family Council, MercatorNet, the Illinois Family Institute, the Family Research Council, the Heritage Foundation’s Daily Signal, and an advocacy group of anti-gay therapists.

Their political disposition and their endorsement of this new “diagnosis” are not coincidental. “Rapid onset gender dysphoria” merely serves to put a name to what was already an observed tendency among disapproving adults: the denial that their child could be transgender, the belief that this identity has been imposed externally by some sinister “other” that is somehow persuasive enough to alter a person’s very gender, and the insistence that transgender youth should be treated in just about any way other than acceptance and affirmation.

As we continue to wait for any firm evidence that this phenomenon exists in its own right, something else is becoming increasingly clear: rapid onset gender dysphoria is less a scientific or clinical construct, and more an “alternative fact” made to order for parents who struggle to cope with the reality of having a transgender or gender-questioning child. ■

References

• American Psychiatric Association. (2013). Gender dysphoria. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• Byne, W., Bradley, S., Coleman, E., Eyler, A. E., Green, R., Menvielle, E. J., . . . Tompkins, D. A. (2012). Report of the APA Task Force on Treatment of Gender Identity Disorder. American Journal of Psychiatry, 169(8), 1–35. [Full text]
• Heylens, G., Elaut, E., Kreukels, B. P. C., Paap, M. C. S., Cerwenka, C., Richter-Appelt, H., . . . De Cuypere, G. (2014). Psychiatric characteristics in transsexual
  individuals: multicentre study in four European countries. British Journal of Psychiatry, 204(2), 151–160. [Full text]
• Littman, L. L. (2017). Rapid onset of gender dysphoria in adolescents and young adults: a descriptive study. Journal of Adolescent Health, 60(2), S95-S96. [Abstract]
• Marchiano, L. (2017). Outbreak: on transgender teens and psychic epidemics. Psychological Perspectives: A Quarterly Journal of Jungian Thought, 60(3), 345–366. [Full text]
• Strang, J. F., Meagher, H., Kenworthy, L., de Vries, A. L. C., Menvielle, E., Leibowitz, S., . . . Anthony, L. G. (2018). Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. Journal of Clinical Child & Adolescent Psychology, 47(1), 105–115. [Abstract]
• Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14(5), 404–411. [Full text]