부모 설문, 십대 또래 집단의 '급성 발병 성별 불쾌감'을 제안: 가설일 뿐 검증된 진단이 아님

급성 성별 불쾌감 징후를 보이는 것으로 인식된 청소년과 청년에 대한 부모 보고

Authors: Lisa Littman
Journal: PLOS ONE
Year: 2018
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330

Summary

Lisa Littman surveyed 256 parents who believed their teenage or young adult child, mostly girls, suddenly developed gender distress around or after puberty. Parents described earlier mental health problems, friend groups where several friends came out as trans together, heavy social media use, and worsening mental health and family relationships. From this, Littman proposed the idea of 'rapid-onset gender dysphoria' (ROGD). Parents were found through three websites sceptical of youth transition, and the young people themselves were never asked. After a second review, the journal republished the paper in 2019 with new wording stressing that ROGD is not a proven diagnosis. Critics (such as Restar 2020) disputed the methods, and a 2022 study of Canadian clinics did not find the links the idea predicts. The paper is best read as an early, disputed idea.

Key findings

부모 256명이 참여했습니다. 이들이 설명한 청소년은 대부분 출생 시 여성(82.8%)이었고 평균 연령은 16.4세였으며, 평균 약 15세에 트랜스젠더 정체성을 선언했습니다.
부모에 따르면 62.5%가 성별 불쾌감이 시작되기 전에 정신 건강 또는 발달 진단이 적어도 하나 있었고, 41%는 그 전에 이성애자가 아니라고 말한 적이 있었습니다.
설명된 친구 집단의 36.8%에서 부모는 대부분의 친구가 트랜스젠더로 커밍아웃했다고 말했습니다. 부모의 86.7%는 소셜 미디어 사용 증가, 트랜스로 정체화한 친구 집단, 또는 둘 다를 보고했습니다.
자녀가 커밍아웃한 뒤 부모들은 자녀의 정신 건강이 나빠졌고(47.2%) 부모와 자녀의 관계가 나빠졌다(57.3%)고 보고했습니다. 49.4%는 자녀가 가족과 단절하려 했다고 말했습니다.
부모의 76.5%는 자녀가 자신이 트랜스젠더라고 생각하는 것이 틀렸다고 믿었으므로, 응답한 부모 대부분은 자녀의 정체성에 의심을 갖고 있었습니다.
이 연구는 10대에 시작되는 일부 성별 불쾌감이 사회적 영향을 받거나 건강하지 않은 대처 방식이라는 생각을 제기하지만 검증하지는 않습니다. 청소년이나 그들의 임상의로부터는 아무것도 수집하지 않았습니다.
2019년 3월 저널은 원본을 수정판으로 교체했습니다(새 제목, 다시 쓴 요약, 서론, 논의, 결론). ROGD가 공식 진단이 아님을 강조했습니다. 결과 부분은 기본적으로 바뀌지 않았습니다.

Abstract

Purpose: In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria. The purpose of this study was to collect data about parents’ observations, experiences, and perspectives about their adolescent and young adult (AYA) children showing signs of an apparent sudden or rapid onset of gender dysphoria that began during or after puberty, and develop hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among this demographic group.

Methods: For this descriptive, exploratory study, recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youthtranscriticalprofessionals) were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes.

Results: There were 256 parent-completed surveys that met study criteria. The AYA children described were predominantly natal female (82.8%) with a mean age of 16.4 years at the time of survey completion and a mean age of 15.2 when they announced a transgender-identification. Per parent report, 41% of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had reportedly been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, parent participants indicated that the majority of the members became transgender-identified. Parents reported subjective declines in their AYAs’ mental health (47.2%) and in parent-child relationships (57.3%) since the AYA “came out” and that AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%). Most (86.7%) of the parents reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar timeframe, or both.

Conclusion: This descriptive, exploratory study of parent reports provides valuable detailed information that allows for the generation of hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria (referred to as rapid-onset gender dysphoria) that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms. Parent-child conflict may also explain some of the findings. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.

Conclusion

Collecting data from parents in this descriptive exploratory study has provided valuable, detailed information that allows for the generation of hypotheses about potential factors contributing to the onset and expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria (referred to as rapid-onset gender dysphoria) that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms contributing to the development of gender dysphoria. Parent-child conflict may also contribute to the course of the dysphoria. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.

Methodological limitations

Parents found through sceptical websites: Survey notices were posted on 4thwavenow, Transgender Trend and Youth Trans Critical Professionals, which the paper itself describes as cautious about or critical of youth transition, then passed on by word of mouth. Parents who share those views are almost certainly over-represented.
Only parents were asked: No teenagers, young adults or clinicians took part, so when the distress started, how the child felt, their mental health and their online life are all parents' impressions. The 2019 correction notes some answers 'might reflect parent perspectives', and critics (Brandelli Costa's formal comment in the journal, 2019, and Restar 2020) point to evidence that parents and children often report things differently.
Most parents disagreed with their child: 76.5% believed their child was wrong to think they were transgender. That raises the risk that parents read events through their own views. For example, they may not have known about earlier distress, or may have seen their child's behaviour as peer influence.
The group was picked for the pattern it describes: To take part, parents had to say the distress started suddenly. The term 'rapid onset gender dysphoria' first appeared on the recruiting sites in the study's own notice, so the sample was chosen for the very pattern it reports.
No comparison group, description only: Without parents of other young people with gender distress, or of young people without it, we can't tell whether earlier diagnoses, social media use or friend groups coming out together are unusual. The correction states no claims about cause can be made.
Home-made questionnaire: The author wrote the 90-question survey herself, with no tested measures of gender distress, mental health or social media use. Critics (Restar 2020) also said some questions were worded in a leading way.
Answers couldn't be checked: Answers were collected anonymously online, with no check of who people were or of the diagnoses reported. Beyond the author's own data cleaning, there was no way to rule out repeat or off-topic answers.
Very similar respondents: 91.7% were mothers, 91.4% White and 71.7% in the US, which limits how far the results apply to others.
Corrected after publication: After a second look by the journal's editors, two academic editors, a statistics reviewer and an outside expert, the paper was republished in March 2019 with a new title and rewritten summary, introduction, discussion, conclusion and conflicts statement. The original claim that ROGD 'appears to represent an entity that is distinct' was replaced with wording stressing it 'has not yet been clinically validated'. The results were basically unchanged.
Published criticism and reply: Restar (Archives of Sexual Behavior, 2020) argued the sampling, survey design and missing youth voices make the findings unreliable. Ashley (Sociological Review, 2020) criticised the idea itself. Littman replied (2020) that her methods match other first descriptive studies in the field, and Hutchinson, Midgen and Spiliadis (2020) argued the idea deserves research.
Later evidence against it: Bauer, Lawson and Metzger (Journal of Pediatrics, 2022) tested links the idea predicts in clinic records of 173 teenagers at 10 Canadian clinics and found no support. Littman (2022) replied that their measure didn't really capture sudden onset, so the question is still disputed.
Not a recognised diagnosis: ROGD is not in the main psychiatric diagnosis manuals (DSM-5-TR and ICD-11). Some professional bodies, such as WPATH in a 2018 statement, have objected to its use, which limits how the term should be applied to individual young people.

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Summary

Key findings

Abstract

Conclusion