Human biology is pretty clear, that at birth we are either born a female (XX) or a male (XY). There are two distinct sexes. That being said, there are a growing number of adolescents who are struggling with what is known as a teenage gender identity crisis, or gender dysphoria. Gender dysphoria refers to the disconnect between the sex the individual is born with and the gender they identify with psychologically.
When the teen is torn between their biological sex and the gender they desire to be it can cause significant emotional distress. The teen may begin to dress and acquire mannerisms that align with the gender identity of choice, which can result in bullying, ridicule, and social shaming. This only exacerbates their self-image challenges and can trigger a mental health condition.
Gender dysphoria can first arise in childhood, when, for example a little boy prefers to play with girls and toys intended for girls, and may even want to wear girl’s clothing. Childhood gender dysphoria, however, tends to resolve by late adolescence with 98% of boys accepting their biologically determined sex and 88% of girls doing so, states the American College of Pediatricians in a 2017 press release. There is much controversy surrounding the practice of doctors assisting a pre-pubescent child with gender dysphoria to delay puberty or to influence sex traits medically.
A teenage gender identity crisis becomes disordered when he or she experiences major distress or impairment due to a disconnect between the assigned sex and gender identity. According to the DSM-5, gender dysphoria is defined as follows:
Gender Dysphoria: A marked incongruence between one’s experience/expressed gender and assigned gender, of at least a six months duration, and is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or anticipated secondary sex characteristics)
- A strong desire to be rid of one’s primary and/or secondary sex characteristics, or to prevent the development of the secondary sex characteristics
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of the other gender
The DSM 5 also changed the diagnosis from “gender identity disorder” in the DSM-4 to gender dysphoria.
The mental health community has seen a significant increase sudden-onset gender dysphoria in adolescents who had not displayed any signs of gender dysphoria during childhood. The majority of these cases are female-at-birth individuals. A researcher from Brown University, assistant professor of behavioral and social sciences, Lisa Littman, conducted a survey of 250 parents of such teens. Interestingly, 80% of the parents who responded to the survey had not seen any of the symptoms of gender dysphoria when their teen was a child. In addition, a fifth of the respondents noted that their teen had some friends recently come out as “transgender” at about the same time as they teen began questioning their biological sex assignment. Some question whether clusters of teens with gender dysphoria are being influenced through group dynamics or social media.
Comorbid Mental Health Disorders
A teen with gender dysphoria is more likely to develop a mental health disorder than the general population. According to a meta-study conducted in 2016 reviewed 38 studies that centered around gender dysphoria and levels of psychiatric comorbidity. The analysis concluded that individuals struggling with gender dysphoria have a higher incidence of psychiatric problems, although the rate decreases after they have gender-confirming treatment.
The most common mental health disorders that co-occur with gender dysphoria are depression, anxiety, and substance use disorders:
Depression. The rate of depression among transgender youths is approximately 50%, compared with 7% in the general population. According to the National Alliance on Mental Illness, gay, lesbian, or bisexual teens are nearly 5 times more likely to attempt suicide as their heterosexual peers.
Anxiety. Anxiety symptoms may arise in teens with gender dysphoria, as the teen faces social distress due to the teenage gender identity crisis. They may become so anxious about going to school or social functions that they begin to isolate and withdraw from peers. In addition, the teen may begin to engage in self-harming behaviors.
Substance abuse. Teens with gender dysphoria may utilize alcohol or drugs to help ease the resulting emotional disturbance. Self-medicating with substances can result in a co-occurring substance use disorder.
Signs of Teenage Gender Identity Crisis
Parents may notice their teen exhibiting certain signs and symptoms that indicate a problem with gender identity. Parents may initially be unprepared for the onset of this condition and attempt to persuade the adolescent to discontinue the behaviors associated with their perceived gender. These behaviors might include:
- Wearing clothing normally associated with the opposite sex. Males using make-up.
- Attempting to hide secondary sexual characteristics, such as girls wrapping their breasts or males removing their body hair
- Showing disgust toward their genitalia
- Affecting mannerisms and speech that match their gender identity
- Asking parents and siblings to use the pronoun of the opposite sex when addressing them
- Using a new name
- Urinating in the method of the opposite sex
- Persistent insistence that they were born the wrong sex
Teens with gender dysphoria may skip school or stop participating in their usual extracurricular sports or activities. They may show signs of low self-esteem or suicidal ideation.
Suicidality Among Individuals with Gender Dysphoria
There is a marked risk of suicidal behavior among teens with gender dysphoria. According to an article published by Reuters Health, transgender teens have a significantly higher risk of suicidal behavior. The article cites a study out of the University of Arizona, Tuscon that reported the following statistics:
- Approximately 50% of teens that were born female but identify as male have attempted suicide at least once.
- 30% of teens born male but identify as female have attempted suicide at least once.
- 28% of teens questioning their gender identity have attempted suicide at least once.
The risk factors for suicide among teens with gender dysphoria include:
- Family rejection
- Being discriminated against
- Being bullied or harassed
- Feeling they do not fit in
- Feeling they are a burden to their family
Parents of trans teens should become educated about the warning signs for suicide. These red flags include:
- Changes in eating habits
- Changes in sleeping habits
- Withdrawing from friends and family
- Agitation, restlessness
- Decline in academic performance
- Giving their prized possessions away
- Mood swings
- Unusual violent or rebellious behavior
- Talking about wanting to die
How to Support Your Teen with Gender Dysphoria
Teens who are struggling with gender identity issues need, above all else, to feel that their family accepts them and supports them. Family acceptance and love is the number one protective factor for reducing the risk of suicide. When the overt signs of gender confusion emerge, it is best to have a frank and open conversation with the teen, while withholding all judgment.
Parents can assist their teen during this tumultuous time by becoming educated about the condition, as well as possible treatment measures. Parents should not rush into any gender reassignment treatments or surgeries, as the condition may resolve in time. Gender transitioning regret is real. Many who undergo gender reassignment continue to struggle psychologically, and have regrets about pursuing the drastic methods to change their gender, as the treatments can cause more suffering.
Mental Health Treatment for Co-Occurring Depression or Anxiety
When gender dysphoria is accompanied by a mental health disorder, getting professional treatment with a mental health practitioner is essential. The psychotherapy and medications provided may drastically reduce the possibility of an attempted suicide. Outpatient mental health treatment includes:
- Psychotherapists will work with the teen to help them work through the core identity issues. In therapy, the teen can learn about the pros and cons of transitioning, as well as offering healthy coping strategies for daily functioning as a trans teen.
- Family therapy. The family is the central source of emotional support for the teen, so family-centered therapy can be helpful in guiding family members toward developing positive, affirming messaging. Family therapy also allows the teen to share with their family ways they may be unknowingly causing emotional pain.
- Support groups are a helpful resource for teens with gender dysphoria, as these informal gatherings allow teens to share their own experiences and feelings among others with the same challenges.
- Medication may be helpful for managing the symptoms of depression or anxiety. Antidepressants should be closely monitored, as young patients may be subject to an adverse side effect that can increase suicidal thoughts.
If the teen’s mental health disorder escalates beyond the treatment scope of the outpatient provider, residential teen mental health services are available to offer acute stabilization services and more intensive therapeutic support.
The Treatment Specialist Offers Helpful Information About Gender Dysphoria
The Treatment Specialist provides information and data regarding teenage gender identity crisis and mental health disorders. This information assists the individual struggling with gender dysphoria to better understand the treatment options for both the gender dysphoria and any comorbid mental health disorders. Our specialists are available to provide free guidance and insurance checks for individuals needing help for a loved one with gender dysphoria. For more information and guidance, please contact The Treatment Specialist today at (866) 644-7911.