Teens attempting to address “feeling uncomfortable in their own skins or feeling like they don’t fit in” are looking to ‘transgender’ peers and social media for belonging/acceptance/reinforcement, resulting in/reinforcing beliefs that “the only path to happiness is transition” and “anyone who disagrees…is transphobic and should be cut out of their life.” Young adults are using ‘transitioning’ as a “harmful coping mechanism [like drugs, alcohol, or cutting]…to avoid feeling negative emotions.”
Rapid Onset Gender Dysphoria (ROGD) is resulting in “The worsening of mental well-being and parent-child relationships and behaviors that isolate [adolescents and young adults] from their parents, families, non-transgender friends and mainstream sources of information…”
- Rapid Onset Gender Dysphoria: gender dysphoria that was not present in early youth
- Social Contagion: the spread of affect or behaviors through a population, esp. via peer groups (peer contagion) and online social interaction
The AYAs who were the focus of this study had many comorbidities and vulnerabilities predating the onset of their gender dysphoria, including psychiatric disorders, neurodevelopmental disabilites, trauma, non-suicidal self-injury (NSSI), and difficulties coping with strong or negative emotions. The majority (62.5%) of AYAs had one or more diagnoses of a psychiatric disorder or neurodevelopmental disability preceding the onset of gender dysphoria (range of the number of pre-existing diagnoses 0–7). 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). Almost half (45.0%) of AYAs were engaging in non-suicidal self-injury (NSSI) behavior before the onset of GD. Coping styles for these AYAs included having a poor or extremely poor ability to handle negative emotions productively (58.0%) and being overwhelmed by strong emotions and trying to avoid (or go to great lengths to avoid) experiencing them (61.4%) (Table 4). The majority of respondents (69.4%) answered that their child had social anxiety during adolescence; 44.3% 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).
- Social contagion is a key determinant of ROGD
- ROGD is a maladaptive coping mechanism for adolescents and young adults
Rapid-onset gender dysphoria describes a phenomenon where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood. ROGD appears to represent an entity that is distinct in etiology from the gender dysphoria observed in individuals who have previously been described as transgender. It is plausible that ROGD represents an ego-syntonic maladaptive coping mechanism for some AYAs and that peer group and online influences may contribute to its development. It is unknown whether the gender dysphoria of rapid-onset gender dysphoria is temporary or likely to be long-term. The elevated number of friends per friendship group who became transgender-identified, the pattern of cluster outbreaks of transgender-identification in these friendship groups, the substantial percentage of friendship groups where the majority of the members became transgender-identified, and the peer group dynamics observed all serve to support the plausibility of social and peer contagion for ROGD. The worsening of mental well-being and parent-child relationships and behaviors that isolate teens from their parents, families, non-transgender friends and mainstream sources of information are particularly concerning. More research is needed to better understand rapid-onset gender dysphoria, its implications, and scope.