Comorbidity

Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors.

Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors. Expand
Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors.

A Swedish study [1] points out that it is “difficult to distinguish one [gender dysphoria] from the other [mental health conditions] with regard to suicide risk.”

A 2019 study [2] finds that “adolescents referred for gender dysphoria show higher rates of suicidality when compared to non-referred adolescents, but are much more similar to referred adolescents (presumably, the vast majority were cisgender) in general.”

REFERENCES

[1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

[2] Zucker, K. J. (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior 48 (5). [Link]

People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people.

People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people. Expand
People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people.

A Swedish study [1] found that suicide rates for personality disorder, schizophrenia, substance addiction, bipolar and (among males) depression and autism were all higher than suicide rates for gender dysphoric people:

These high suicide rates for schizophrenia are confirmed by another study [2] which puts the lifetime risk of suicide death for schizophrenics at 5.6%. This study also finds “the absolute risk of suicide in different psychiatric disorders to vary from 2% to 8%, higher for men than for women and highest for men and women with bipolar disorder, unipolar affective disorder, schizophrenia, and schizophrenialike disorder.”

REFERENCES

[1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

[2] Nordentoft, M., Madsen, T. & Fedyszyn, I. (2015). Suicidal behavior and mortality in first-episode psychosis. J Nerv Ment Dis. 203 (5): 387-92. [Link]

There seems to be a connection between disordered eating patterns and gender-related distress.

There seems to be a connection between disordered eating patterns and gender-related distress. Expand
There seems to be a connection between disordered eating patterns and gender-related distress.

In a review [1] of 20 publications, a consistent theme emerged: transgender youth (aged 8 to 25) engaged in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression.

The review suggested that, for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress. However, the exact nature of this observed connection is uncertain.

REFERENCES

[1] Coelho, J., Suen, J., Clark, B., Marshall, S., Geller, J. & Lam, P.-Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current Psychiatry Reports 21. [Link]

Transgender-identified youth are disproportionately likely to suffer from eating disorders.

Transgender-identified youth are disproportionately likely to suffer from eating disorders. Expand
Transgender-identified youth are disproportionately likely to suffer from eating disorders.

In a review [1] of 20 publications, significantly higher rates of eating disorder symptoms were documented in transgender youth (aged between 8 and 25).

Another study [2] corroborated this connection, noting that data, while scarce, suggest “an overrepresentation of eating pathology among adolescents with GD [gender dysphoria] or transgender identity.”

REFERENCES

[1] Coelho, J., Suen, J., Clark, B., Marshall, S., Geller, J. & Lam, P.-Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current Psychiatry Reports 21. [Link]

[2] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

Transgender-identified youth are prone to elevated rates of depression and/or anxiety.

Trans-identified young people are prone to elevated rates of depression and/or anxiety. Expand
Transgender-identified youth are prone to elevated rates of depression and/or anxiety.

A study [1] which compared the medical records of 1333 trans-identified children and adolescents between the ages of 3 and 17 years old with a similar cohort of non-trans-identified children and adolescents showed that 49% of males and 62% of females had depressive disorders.

An Australian study [2], with a smaller sample of gender dysphoric children and adolescents, found depression and anxiety rates of 62.0% and 63.3% respectively.

The majority of parent respondents in Littman’s 2018 study [3] – 69.4% – answered that their child had social anxiety during adolescence; 44.3% said that their child had difficulty interacting with their peers, and 43.1% that their child had a history of being isolated (not associating with their peers outside of school activities).

Similar conclusions have been found [4] for adults with gender dysphoria, who suffer from elevated rates of mood disorders (48.9% among natal males, 36.1% among natal females) and anxiety (38.8% among natal males, 33.3% among natal females). A further paper [5] found somewhat lower figures, giving a prevalence of 42.1% for mood disorders and 26.8% for anxiety disorders.

REFERENCES

[1] Becerra-Culqui, T.A. Liu, Y., Nash, R., Cromwell, L., Flanders, W.D., Getahun, D. Giammattei, S.V., Hunkeler, E.M., Lash, T.L., Millman, A., Quinn, V.P., Robinson, B., Roblin, D., Sandberg, D.E., Silverberg, M.J., Tangpricha, V. & Goodman, M. (2018). ‘Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics 141(5). [Link]

[2] Kozlowska, K., McClure, G., Chudleigh, C., Maguire, A.M., Gessler, D., Scher, S. & Ambler, G.R. (2021). ‘Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service’. Human Systems, 1(1), 70–95. [Link]

[3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

[4] Mazaheri Meybodi, A., Hajebi, A., & Ghanbari Jolfaei, A. (2014). Psychiatric Axis I: Comorbidities among Patients with Gender Dysphoria. Psychiatry journal 2014. [Link]

[5] de Freitas, L. D., Léda-Rêgo, G., Bezerra-Filho, S., & Miranda-Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74 (2), 99–104. [Link]

People with an incongruent gender identity are over four times more likely than the general population to suffer from mental health problems.

People with an incongruent gender identity are much more likely than the general population to suffer from mental health problems. Expand
People with an incongruent gender identity are over four times more likely than the general population to suffer from mental health problems.

This finding, from an American campus survey [1], found that gender minority status was associated with “4.3 times higher odds of having at least 1 mental health problem.” Similarly, a Journal of Sex and Marital Therapy article [2] notes that “a large percentage of adolescents referred for gender dysphoria have a substantial co-occurring history of psychosocial and psychological vulnerability.”

In Lisa Littman’s seminal work [3] on rapid onset gender dysphoria, 62.5% of the young people whose parents were surveyed had at least one mental health or neurodevelopmental issue. 58.0% had a poor or extremely poor ability to handle negative emotions productively; 61.4% were overwhelmed by strong emotions and tried to avoid (or went to great lengths to avoid) experiencing them.

In a systematic review [4] of individuals diagnosed with gender dysphoria, 53.2% had at least one mental disorder in their lifetime. Such figures substantially exceed prevalence rates of comorbid psychopathology in the general population [5]: a further paper [6] studying hospital encounters found that the prevalence of mental disorder diagnoses was higher in transgender encounters (77%) than in the general population (37.8%).

A Swedish study [7] found that sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder (other than gender identity disorder) than the control population. Inpatient care for psychiatric disorders was also significantly more common among sex-reassigned persons than among controls, both before and after sex reassignment.

REFERENCES

[1] Lipson, S. K., Raifman, J., Abelson, S. & Reisner, S. L. (2019). Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. American Journal of Preventive Medicine 57 (3): 293-301. [Link]

[2] Bechard, M., VanderLaan, D. P., Wood, H., Wasserman, L. & Zucker, K. (2017). Psychosocial and Psychological Vulnerability in Adolescents with Gender Dysphoria: A “Proof of Principle” Study. Journal of Sex & Marital Therapy 43 (7). [Link]

[3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

[4] de Freitas, L. D., Léda-Rêgo, G., Bezerra-Filho, S., & Miranda-Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74 (2), 99–104. [Link]

[5] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

[6] Bishoy, H., Repack, D., Tarang, P., Guirguis, E., Kumar, G. & Sachdeva, R. (2019). Psychiatric disorders in the U.S. transgender population. Annals of Epidemiology 39: 1-7. [Link]

[7] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS ONE, 6(2). [Link]

Children with ADHD are far more likely than average to express gender variance.

Children with ADHD are far more likely than average to express gender variance. Expand
Children with ADHD are far more likely than average to express gender variance.

A study on children [1] found that, as compared to non-referred comparisons, participants with ADHD were 6.64 times more likely to express gender variance than participants without ADHD. The study also found that, in cases of ADHD, this gender variance was related to elevated emotional symptoms.

REFERENCES

[1] Strang, J.F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L.E., Berl, M., Walsh, K., Menvielle, E., Slesaransky-Poe, G., Kim, K.E., Luong-Tran, C., Meagher, H. & Wallace, G.L. (2014) Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Arch Sex Behav 43 (8): 1525-33. [Link]

Roughly 15% of transmasculine and transfeminine youths in one study had attention deficit disorders.

Roughly 15% of transmasculine and transfeminine youths in one study had attention deficit disorders. Expand
Roughly 15% of transmasculine and transfeminine youths in one study had attention deficit disorders.

A study [1] which used electronic medical records to identify transmasculine and transfeminine youths found attention deficit disorders in 15% of males and 16% of females.

REFERENCES

[1] Becerra-Culqui, T.A. Liu, Y., Nash, R., Cromwell, L., Flanders, W.D., Getahun, D. Giammattei, S.V., Hunkeler, E.M., Lash, T.L., Millman, A., Quinn, V.P., Robinson, B., Roblin, D., Sandberg, D.E., Silverberg, M.J., Tangpricha, V. & Goodman, M. (2018). ‘Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics 141(5). [Link]

Obsessive-compulsive traits are more common in people with gender dysphoria.

Obsessive-compulsive traits are more common in people with gender dysphoria. Expand
Obsessive-compulsive traits are more common in people with gender dysphoria.

At least two studies [1, 2] have found a particular connection between intense interests or repetitive behaviors – associated with autism spectrum disorders – and gender dysphoria.

It has also been noted [3] that

With the intensified public awareness and media coverage of issues concerning gender identity and gender incongruence, distinguishing true gender dysphoria or incongruence from the sexual obsessions of obsessive-compulsive disorder (OCD) is especially important. Although intrusive sexual obsessions are not uncommon in OCD, obsessions concerning sexual content are more difficult for clinicians to identify as OCD than other types of obsessions (e.g., obsessions concerning contamination). 

REFERENCES

[1] Zucker, K.J., Nabbijohn, A.N., Santarossa, A., Wood, H., Bradley, S.J., Matthews, J., & VanderLaan, D.P. (2017). Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher’s Report Form. Child and adolescent psychiatry and mental health 11, 51. [Link]

[2] VanderLaan, D.P., Postema, L., Wood, H., Singh, D., Fantus, S., Hyun, J., Leef, J., Bradley, S.J. & Zucker, K.J.. (2015). Do children with gender dysphoria have intense/obsessional interests? J Sex Res. 52 (2): 213-9. [Link]

[3] Safer, D., Bullock, K. & Safer, J. (2016). Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review. AACE Clinical Case Reports 2. [Link]

Children referred to the UK’s largest gender clinic were vastly more likely than average to present with autistic traits.

Children referred to the UK’s largest gender clinic were vastly more likely than average to present with autistic traits. Expand
Children referred to the UK’s largest gender clinic were vastly more likely than average to present with autistic traits.

One study [1] noted that:

48% of children and young people who were seen in GIDS and whose parents completed the social responsiveness scale (SRS), a quantitative measure of autistic behaviours in children and young people, scored in the mild to severe range.

A BMJ paper [2] reported:

Around 35% of referred young people [i.e. referred to the GIDS] present with moderate to severe autistic traits.

REFERENCES

[1] Churcher Clarke, A. & Spiliadis, A. (2019). ‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties. Clin Child Psychol Psychiatry 24 (2): 338-352. [Link]

[2] Butler, G., De Graaf, N., Wren, B. & Carmichael, P. (2018) Assessment and support of children and adolescents with gender dysphoria. Archives of Disease in Childhood103:631-636. [Link]