5 unanswered questions about the “rapid onset gender dysphoria” hoax diagnosis

Zinnia Jones“Rapid onset gender dysphoria” is a proposed diagnosis applied to teen trans boys, positing that their dysphoria appears suddenly in adolescence as the result of receiving it via “social contagion”, such as by having trans friends or reading about trans people online. It is claimed to have emerged only recently and to constitute a distinct condition from traditional gender dysphoria. This alleged condition was originally created by several anti-trans advocacy sites, and given a scientific gloss with an unpublished study of the site visitors’ responses to an anonymous survey about their children’s dysphoria and gender identity development.

Since that study, no further clinical information has been published about this supposed population of youth experiencing a new form of gender dysphoria. As a result, much remains unknown about this phenomenon, including whether it actually is a distinct phenomenon. There are numerous open questions about “rapid onset gender dysphoria” that have yet to be satisfactorily answered. Knowing more about trans youth is key to understanding how best to treat them, and at present, the notion of rapid onset gender dysphoria offers little in the way of clarity.

1. How has the course of onset been verified? This diagnosis proposes that these teens are formerly non-dysphoric, but that during puberty they suddenly acquire dysphoria. This is based entirely on the reports of parents, and given that many trans youth conceal their identities for fear of disapproval or punishment, parental reports do not rule out the possibility of a previously present gender dysphoria that was simply revealed recently.

2. How do internet usage and “social contagion” differ between rapid onset gender dysphoria and traditional gender dysphoria? Proponents of the rapid onset diagnosis have claimed that these youths “became” transgender after engaging with online communities of trans people on Tumblr, YouTube, Reddit, and elsewhere, indicating a “socially contagious” phenomenon. But seeking out information on transness from online sources is a crucial way for questioning people to understand themselves better. How does this look any different from a closeted teen reading about trans people online for the first time, and realizing that these descriptions apply to their own life? How do we know that their dysphoria didn’t predate and give rise to their online engagement with trans-related materials, something which is already known to occur? And why does a mechanism of “social contagion” need to be proposed to explain the rise in trans youth seeking treatment, when this can already be accounted for by the factors leading to the rise in trans adults seeking treatment? What observations exist to distinguish between these possibilities?

3. Why should teens with “rapid onset gender dysphoria” and comorbid psychiatric conditions be treated differently from those with traditional gender dysphoria and comorbid conditions? Advocates of the “rapid onset” diagnosis, like Debra Soh, Ray Blanchard and J. Michael Bailey, have claimed that these youth are autistic or experiencing borderline personality disorder or other conditions, and that such conditions “should be the focus of concern instead” – “Identify your child’s problems that existed before”. But existing literature recognizes that trans people with genuine gender dysphoria may also experience autism, personality disorders, or other mental health issues as comorbid conditions. The presence of these conditions doesn’t preclude gender dysphoria, nor is it considered to rule out gender-affirming treatment.

How do advocates of the diagnosis distinguish “rapid onset” trans youth, whose apparent dysphoria is caused by other mental health struggles, from trans youth with both traditional gender dysphoria and comorbid mental health conditions? The possible presence of such conditions has already been accounted for by what we currently know about transness, without needing to be explained by proposing an entirely new form of gender dysphoria.

4. How should treatment for “rapid onset” dysphoria differ from treatment for traditional dysphoria, and why? Blanchard and Bailey claim that gender-affirming treatments are “least justifiable” in cases of rapid onset dysphoria because it is a “false belief acquired through social means”, and that these youth should “delay any consideration of gender transition”. But practically nothing is known about the actual course of gender identity development in these “rapid onset” youth. The origin of their dysphoria as first appearing rapidly in adolescence has not even been confirmed, and there is no information on how long this “false belief” dysphoria might persist, or if rapid onset youth are more likely to desist than youth with traditional dysphoria. No evidence exists comparing the results of affirming treatment in rapid onset youth and traditionally dysphoric youth, and studies of trans youth accepted for treatment with puberty blockers show extremely high rates of satisfaction, suggesting that there is not a population with “false” dysphoria who have been mistakenly given affirming treatment.

5. Where is the evidence? Existing studies of trans youth include more evidence than anonymous online surveys answered by parents. They include case series, case reports, and clinical evaluations of trans youth themselves. In the case of “rapid onset gender dysphoria”, no such evidence has been published. Stronger and more consistent evidence is needed before the case for an entirely new form of gender dysphoria can be persuasively made, particularly when most phenomena proposed to be part of this condition can already be explained under existing models.

This proposed diagnosis does not only fail to clarify the most beneficial approach to treating these “rapid onset” youth. The lack of clear parameters for this phenomenon allows for plenty of trans youth with the already-established typical form of gender dysphoria to be inappropriately labeled as “rapid onset”, such as youth who concealed their identities from their parents, youth who learned the language for who they are via friends or online resources, and youth who also face mental health struggles. Given that proponents of the rapid onset diagnosis recommend that gender-affirming treatment be withheld from these youth, all trans youth are thus placed at risk of being denied necessary treatment. Whether “rapid onset” or not, these youth may be deprived of the known benefits of affirming care and face the well-recognized harms of non-treatment. A better model of this supposed dysphoria is necessary – as is, this superfluous diagnosis adds much confusion and little clarity. 

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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