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There Is No Evidence That Rapid-Onset Gender Dysphoria Exists

Rapid-onset gender dysphoria (ROGD) is the name given to a hypothesized new clinical subgroup of transgender youth, which would be characterized by coming out as transgender out of the blue in adolescence or early adulthood. Under this hypothesis, which is unsupported by evidence, children with ROGD falsely believe they are transgender due to social influence, trauma, and experiences of sexual objectification.

ROGD is mostly strongly associated with the work of Dr. Lisa Littman, who published a study purporting to substantiate the hypothesis of ROGD. The study was based on the reports of parents recruited from well-known, anti-trans websites.

As the World Professional Association for Transgender Health wrote, “it is both premature and inappropriate to employ official-sounding labels that lead clinicians, community members, and scientists to form absolute conclusions about adolescent gender identity development,” pointing out that ROGD “is not a medical entity recognized by any major professional association.”1

In March, 21 experts in trans health endorsed an essay concluding that the hypothesis of ROGD is bad science.2 The group included multiple past presidents of the Canadian Professional Association for Transgender Health, its current president, the heads of the specialized Meraki Health Centre3, and the lead investigator of the Montreal arm of the Trans Youth CAN! studies.

Despite significant sampling and interpretive concerns with the study 4,5, it is not uncommon for it to be uncritically cited as evidence of a social contagion of trans identities.6 I write this article in the hopes of aiding practitioners develop a better understanding of the scientific concerns raised by ROGD and Littman’s study.

The first and most commonly noted problem with the study is its choice of sample. It relies on parental report without independent confirmation and posted recruitment advertising exclusively on anti-trans websites. The websites where participants were recruited discourage parents and the public alike from accepting or affirming the gender identities of trans people and routinely depict all transgender people as deluded and subject to false belief. This introduces a significant bias, as parents are already encouraged to view their children’s identities as false beliefs, and may intentionally or unintentionally misreport certain facts, notably due to recall bias. As I previously noted, it is legitimate for studies to include parental reports.7 However, sole reliance on parental report majorly undermines scientific validity. In the study, parental reports of ROGD were uncritically accepted even when contradicted by the child’s counsellor, therapist, or doctor.

The second and, in my opinion, biggest problem with the study is that Littman fails to consider alternative, more plausible explanations for her observations. One of the main findings of the study is that children’s mental health and parent-child relationships deteriorate after coming out. Littman interprets this as evidence of a new subgroup of trans adolescents for whom social and medical transition may not be indicated. However, parental acceptance of gender identity is a well-known predictor of mental wellbeing for transgender people and children who are not supported in their identities are unlikely to want to maintain a good relationship with their parents.8

Brynn Tannehill cogently explained this chronology of events: “After coming to grips with their gender identity, transgender youth then delay telling hostile parents until they cannot bear not to, which makes it appear to the parents that this came out of nowhere. After they come out, and their parents do not support them, the parent-child relationship deteriorates, and the mental health of the youth declines. An interview I conducted with the (now adult) child of one of the parents who participated in this survey confirms this narrative as true for him.”

A similar interpretive issue arises with regards to social influence. Parents report that their children increased their internet and social media consumption prior to coming out, found themselves in friend groups with many trans people, and demonstrated negative attitudes towards cisgender heterosexual people. None of this is surprising — especially taking into consideration recall bias. People who are questioning their gender tend to find themselves consuming content by trans people, both for informational purposes and because of shared experiences. It isn’t uncommon for trans youth to describe an unexplained fascination with other trans people prior to questioning their gender. Trans men who previously identified as butch lesbians were likely to congregate around other queer people, many of whom likely were gender non-conforming and already questioning their gender.

As for calling cisgender, heterosexual people evil and unsupportive, it bears mentioning that social spaces shared by marginalized groups routinely involve hyperbolic venting and the demonization of groups seen as the oppressor — queer groups joke about “the straights” (including the derogatory term “breeders”), groups for people of color tend to joke about white people (whose resemblance to mayonnaise is noteworthy), and women-only groups ranting about how all men are trash (including the widespread sharing of quotes from Lord of the Rings like “Men? Men are weak”9).

There’s nothing noteworthy about questioning young people consuming social media content representative of their contemporaneous concerns. When academics on BBC Radio claim that “[t]here really isn’t a trans person I’ve met under the age of 30 who hasn’t been on Tumblr,” we should remind ourselves that there aren’t really many people under that age who haven’t been on Tumblr, trans or not.10 We live in a world where social media is omnipresent and is frequently people’s main source of non-academic information.

To support the hypothesis of ROGD, studies would have to reject the null hypothesis. This null hypothesis — that so-called ROGD is a typical presentation of late-onset gender dysphoria among youth with unsupportive parents — is much more plausible given the currently available data. Littman’s study fails altogether to demonstrate the existence of a new clinical population. For the most part, the hypothesis of ROGD has been predicated on the belief that late-onset gender dysphoria was inapplicable, a belief that is grounded in the mistaken assumption that late-onset gender dysphoria is nearly exclusive to children assigned male at birth.

There is no evidence that ROGD exists. So far, all evidence proposed in favor of the hypothesis is best compatible with adolescent-onset gender dysphoria against a background of parental hostility to gender identity.

It is crucial for practitioners to have an adequate understanding of the facts surrounding ROGD, as a mistaken belief that its existence is established could lead to negative consequences in their practice. Hostility toward transgender people is common and even putatively progressive parents often have difficulties accepting the expressed gender identity of their children. Having a child come out as trans is frequently experienced as a form of life narrative disruption11, and belief in ROGD can prevent a healthy narrative reconstruction, leaving parents stuck in at the point of disruption in what Stern, Doolan, Staples, Szmukler and Eisler called “chaotic and frozen narratives.”12 It is essential for parents to move past this disruption to their life story and reconstitute a new one which makes room for their child by accommodating change and giving it meaning within the broader family narrative.

References:

  1. WPATH position on “Rapid-onset gender dysphoria (ROGD)” [release]. (2018, September 4). Retrieved from https://www.wpath.org/media/cms/Documents/Public%20Policies/2018/9_Sept/WPATH%20Position%20on%20Rapid-Onset%20Gender%20Dysphoria_9-4-2018.pdf
  2. Ashley, F., & Baril, A. (2018, March 22). Why ‘rapid-onset gender dysphoria’ is bad science. Retrieved from https://medium.com/@florence.ashley/why-rapid-onset-gender-dysphoria-is-bad-science-f8d25ac40a96
  3. Lalonde, M. (2016, August 12). Trans children: Montreal has resources to help families come to terms. Retrieved from https://montrealgazette.com/news/local-news/trans-children-montreal-has-resources-to-help-families-come-to-terms
  4. Tannehill, B. (2018, February 20). ‘Rapid onset gender disphoria’ is based on junk science. Retrieved from: https://www.advocate.com/commentary/2018/2/20/rapid-onset-gender-dysphoria-biased-junk-science
  5. Serano, J. (2018, August 22) Everything you need to know about rapid onset gender dysphoria. Retrieved from https://medium.com/@juliaserano/everything-you-need-to-know-about-rapid-onset-gender-dysphoria-1940b8afdeba
  6. Veissiere, S. (2018, November 28). Why is transgender identity on the rise among teens? Retrieved from https://www.psychologytoday.com/ca/blog/culture-mind-and-brain/201811/why-is-transgender-identity-the-rise-among-teens
  7. Ashley, F. (2018, August 27). A little less conversation, a little more close reading please: on D’Angelo and Marchiano’s response to Julia Serano on rapid-onset gender dysphoria. Retrieved from https://medium.com/@florence.ashley/a-little-less-conversation-a-little-closer-reading-please-on-dangelo-and-marchiano-s-response-to-10e30e07875d
  8. Bauer, G.R., Scheim, A.I., Pyne, J., Travers, R., & Hammond, R. (2015, June). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(1), 525.Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2
  9. Brown, S. (2017, December 7). [Facebook post]. Retrieved from https://www.facebook.com/photo.php?fbid=10155141181568297
  10. Beyond Binary. (2016, May 29). Retrieved from https://www.bbc.co.uk/programmes/b07btlmk
  11. Giammattei, S.V. (2015, August 17). Beyond the binary: Trans-negotiations in couple and family therapy. Family Process, 54(3): 418-434. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/famp.12167
  12. Stern, S., Doolan, M., Staples, E. Szmukler, G.L., & Eisler, I. (1999). Disruption and reconstruction: narrative insights into the experience of family members caring for a relative diagnosed with serious mental illness. Family Process, 38(3): 353-369. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/10526771
There Is No Evidence That Rapid-Onset Gender Dysphoria Exists

Florence Ashley, B.C.L., LL.B.

Florence Ashley is a transfeminine jurist and bioethicist whose work focuses on a wide range of issues facing trans people in law and healthcare. One of their areas of focus is therapeutic ethics in trans youth care.

APA Reference
Ashley, F. (2018). There Is No Evidence That Rapid-Onset Gender Dysphoria Exists. Psych Central. Retrieved on December 11, 2018, from https://psychcentral.com/lib/there-is-no-evidence-that-rapid-onset-gender-dysphoria-exists/

 

Scientifically Reviewed
Last updated: 3 Dec 2018
Last reviewed: By John M. Grohol, Psy.D. on 3 Dec 2018
Published on PsychCentral.com. All rights reserved.