“Rapid onset gender dysphoria” study: An impossibly wide net of alternative etiologies

One of the most striking features of the recently published “rapid onset gender dysphoria” study is just how many claims are made regarding possible alternative causes for the mere appearance of gender dysphoria rather than genuine gender dysphoria, and how little evidence is presented to substantiate the notion that any of these potential causes would lead to the development of either apparent or genuine gender dysphoria. The study author, Lisa Littman, emphasizes the importance of these supposed causes at length, alleging that other factors could lead these youth to believe falsely that they have gender dysphoria:

Parents described that clinicians failed to explore their child’s mental health, trauma, or any alternative causes for the child’s gender dysphoria. This failure to explore mental health and trauma occurred even when patients had a history of mental health disorder or trauma, were currently being treated for a mental health disorder, or were currently experiencing symptoms. …

In other words, many of the AYAs and their families had been navigating multiple challenges and stressors before gender dysphoria and transgender-identification became part of their lives. This context could possibly contribute to friction between parent and child and these complex, overlapping difficulties as well as experiences of same-sex attraction may also be influential in the development of a transgender identification for some of these AYAs. …

However, it is plausible that the following can be initiated, magnified, spread, and maintained via the mechanisms of social and peer contagion: (1) the belief that non-specific symptoms (including the symptoms associated with trauma, symptoms of psychiatric problems, and symptoms that are part of normal puberty) should be perceived as gender dysphoria and their presence as proof of being transgender … The spread of these beliefs could allow vulnerable AYAs to misinterpret their emotions, incorrectly believe themselves to be transgender and in need of transition, and then inappropriately reject all information that is contrary to these beliefs. In other words, “gender dysphoria” may be used as a catch-all explanation for any kind of distress, psychological pain, and discomfort that an AYA is feeling while transition is being promoted as a cure-all solution….

Transition as a drive to escape one’s gender/sex, emotions, or difficult realities might also be considered when the drive to transition arises after a sex or gender-related trauma or within the context of significant psychiatric symptoms and decline in ability to function. Although trauma and psychiatric disorders are not specific for the development of gender dysphoria, these experiences may leave a person in psychological pain and in search of a coping mechanism.

But just what are these mental health conditions, trauma, and other “stressors” that are leading these youth to believe they’re trans? What, exactly, would cause that? Littman’s answer appears to be: just about anything under the sun. These include depression and anxiety:

Another participant said, “My daughter saw a child therapist and the therapist was preparing to support transgendering and did not explore the depression and anxiety or previous trauma.”

Sexual trauma:

One parent described. “Her current therapist seems to accept her self diagnosis of gender dysphoria and follows what she says without seeming too much interested in exploring the sexual trauma in her past.”

Autism spectrum disorders:

Another parent wrote, “The Asperger psychiatrist did not seem to care whether our daughter’s gender dysphoria stemmed from Asperger’s. If our daughter wanted to be male, then that was enough.”

“Gender related trauma”, parents divorcing, the death of a parent, or mental health conditions in other family members:

Before the onset of their gender dysphoria, many of the AYAs had been diagnosed with at least one mental health disorder or neurodevelopmental disability and many had experienced a traumatic or stressful event. Experiencing a sex or gender related trauma was not uncommon, nor was experiencing a family stressor (such as parental divorce, death of a parent, or a mental health disorder in a sibling or parent).

Rape, attempted rape, sexual harassment, abusive romantic relationships, experiencing a breakup, bullying, social isolation, moving, or changing schools:

Many (48.4%) had experienced a traumatic or stressful event prior to the onset of their gender dysphoria. Open text descriptions of trauma were categorized as “family” (including parental divorce, death of a parent, mental disorder in a sibling or parent), “sex or gender related” (such as rape, attempted rape, sexual harassment, abusive dating relationship, break-up), “social” (such as bullying, social isolation), “moving” (family relocation or change of schools); “psychiatric” (such as psychiatric hospitalization), and medical (such as serious illness or medical hospitalization).

Other mental health conditions or neurodevelopmental disabilities mentioned in the survey responses include ADHD, OCD, eating disorders, bipolar disorder, and psychosis. The most obvious issue with this vast array of conditions or events being cited as reasons why a trans youth’s gender dysphoria may not be genuine is that, taken together, these supposed “causes” are all very common:

As the number of proposed “alternative causes” of gender dysphoria multiplies, so do the theoretical gaps: the “rapid onset gender dysphoria” hypothesis must now explain the mechanisms by which each of dozens of issues would produce gender-dysphoric symptoms. How does sexual harassment cause gender dysphoria? How does moving or changing schools cause gender dysphoria? How do breakups cause gender dysphoria? All of these different circumstances are so common that if they were a significant contributor to the development of dysphoria, far more than a mere 0.6% of the population would be trans.

But this is only puzzling if we assume that the intention of the “rapid onset gender dysphoria” hypothesis is to offer real and substantive explanations for how all of these things could happen. More likely, this doesn’t make sense as an explanation because it doesn’t have to make sense as an explanation, and probably isn’t meant to at all.

Instead, what we see here is an offering of pseudoexplanations that serve a distinctly different purpose. Take any individual trans kid, and the odds are favorable that you can find one or more of these conditions or events in their background – particularly given the highly elevated rates of mental health conditions among trans people. This proliferation of alleged causes does make sense as a deliberate strategy to reach for any possible excuse for why a trans youth’s gender dysphoria is not genuine, and apply this invalidation to nearly any trans youth, as seen in the demand by parents that clinicians look for any other possible “alternative cause” rather than accepting  that these youth are simply trans.

This is consistent with the approach recommended by other proponents of ROGD, such as “Parents of ROGD Kids”, who call for “careful, in-depth psychological assessment” to uncover “the root causes of gender dysphoria” – “a long and difficult process, as the roots can be buried deep in the subconscious”. In this way, the search for some “alternative cause” can continue without end – and gender-affirming treatment can be delayed indefinitely.

Littman is critical elsewhere of “vague signs and symptoms called signs of GD”. She does not appear to have applied this critical perspective when vague signs and symptoms are called signs of ROGD.

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About Zinnia Jones

My work focuses on insights to be found across transgender healthcare, public health, psychiatry, and history of medicine, integrating these many perspectives and guided by the lived experiences of trans people. I live in Orlando with my family, and work mainly in technical writing.
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