Just like other mental health conditions, gender dysphoria represents a very complex set of factors and behaviors. This condition is highly disturbing and stressful to the affected individuals and its onset can begin in early childhood. This paper contains an analysis of a case study of a child patient suffering from gender dysphoria. Additionally, the description of signs of gender dysphoria will be presented in this paper alongside the discussion of dysphoria as a preexisting condition hypothesis supported by scientific references.
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Symptoms and Diagnostic Criteria for Gender Dysphoria
Glidden, Bouman, Jones, and Arcelus (2016) noted that in DSM 5, gender dysphoria is the condition that describes the inconsistency between the perceived gender and the one assigned at birth among the affected individuals. Some of the major characteristics of the diagnosis for this condition include a persistent identification with the opposite gender that is often accompanied by serious distress based on one’s assigned gender role, as well as biological sexual features and anatomy. In the video reviewed for this paper, Josie is said to have displayed or been experiencing various signs and symptoms of gender dysphoria that were outlined in the article by Steve Bressert.
In particular, Bressert (2017) specified that some of the most common symptoms of gender dysphoria in children were the strong desire to wear the clothes typically worn by the representatives of the opposite sex, as well as a strong preference for games and toys typically used by the members of the opposite sex. Finally, one’s desire to be called using pronouns of the opposite sex and the display of respective behaviors are also named as the standard gender dysphoria symptoms (Bressert, 2017). Since the age of three, Josie had most of the listed symptoms and strongly identified as a girl regardless of being born and raised as a boy for the first several years of her life.
In the video, Josie is described as having experienced a very stressful period of life due to her gender dysphoria. First of all, the child insisted on being referred to as a girl using female pronouns; secondly, she strongly preferred to have a solely female wardrobe and toys; finally, she related to female gender roles such as breastfeeding and being a mother. Before receiving the treatment prescribed for gender dysphoria, Josie was reported to have had anxiety attacks, be diagnosed with depression, and prescribed various medications for mental conditions including Tourette’s syndrome. The other problems experienced by Josie due to her gender dysphoria were the loss of sleep, frequent tantrums, and screaming. Moreover, Josie also experienced a strong discontent with her sexual anatomy and was reported to have attempted to cut off her penis with nail clippers.
The aforementioned symptom is another standard manifestation of gender dysphoria in children according to Bressert (2017). Also, Josie expressed the desire to grow into a woman and have all the typical primary and secondary sexual characteristics of a female. Also, she stated that she would be happy if her male sexual characteristics could disappear one day and confirmed to be willing to undergo surgery to change her body. Moreover, Josie experienced frustration and anxiety related to her approaching puberty that would inflict the unwanted kinds of change in her body transforming her into a man. Finally, at the end of the video, Josie shared her vision of the future that included the desire to be married to a man, become a mother, and live as a beautiful adult woman. These behaviors characterize Josie as a child affected by gender dysphoria.
Pre-existing Condition Hypothesis
The complexity of gender dysphoria diagnosed in young children is based on the vagueness of this condition and its manifestations and thus, a high chance of over- and under-diagnosing which can result in various levels of harm caused to a child. To be more precise, discussing gender dysphoria, Zucker, and Lawrence (2009) noted that cross-gender behaviors were commonly reported by parents while the actual claims of the children to belong to the opposite sex were quite rare. Also, as specified in the video reviewed for this paper, many of children who display cross-gender behaviors in early childhood tend to grow out of them and start feeling comfortable with their assigned gender after the onset of puberty. In that way, currently, researchers are focused on the identification of the nature of gender dysphoria and the factors that could potentially contribute to the development of this condition.
In particular, the study by Nota et al. (2017) is focused on the exploration of brain functional connectivity of people affected by gender dysphoria since multiple pieces of evidence were collected by researchers previously pointing to the presence of sex-atypical brain activity and features in people with gender dysphoria. Differently put, multiple bodies of research indicate that brain activity of patients with gender dysphoria seems to resemble that of the sex opposite to the one these patients were assigned at birth. However, Nota et al. (2017) also pointed out that in some patients the patterns of functional connectivity detected during the research were not sex-atypical but showed activity specific to gender dysphoria. Interestingly, the researchers found that the functional connectivity of sex-atypical nature was detected only in adolescent transboys and transgirls while prepubescent children diagnosed with gender dysphoria did not show the same patterns (Nota et al., 2017). In that way, it is difficult to state whether gender dysphoria is a disorder that can be acquired with age or is a preexisting condition.
Moreover, Glidden et al. (2016) pointed out that there is a growing number of cases where patients affected by gender dysphoria are also suffering from a concurrent ASD that stands for autism spectrum disorder. Multiple studies explored the co-occurrence of the two conditions to understand whether or not they share the same set of contributing factors and root causes. There is an opinion that the combination of the two disorders may be triggered by the relationships between the affected individuals and their parents that occur in the childhood of the patients (Glidden et al., 2016). In that way, the preexisting condition hypothesis may not be true because the factors involved in the formation of gender dysphoria in children may be rooted in the attitudes of parents and the internal family dynamics experienced by young children.
In the case of Josie, the young child affected by gender dysphoria, the adoption of her younger sister could initiate certain dynamics and changed the child’s perception of herself. In fact, at the beginning of the video, it was explained that one of the first signs of gender dysphoria displayed by Josie was her strong gravitation to the toys and roles of her baby sister. In that way, it could be possible that the appearance of the second child in the family could create a stressful environment for Josie and result in the onset of her dysphoria.
Facts vs. Myths, Misinformation & Disinformation
Factual and Non-factual Sources of Information
Very often, feeling unwell or being bothered by certain health issues for a while, people avoid going to see a doctor right away and instead turn to the Internet for help. In particular, individuals affected by various mild and serious conditions tend to start searching for information about their symptoms online. This activity could result in a variety of outcomes some of which are self-medication and self-diagnosing that can be very dangerous especially when based on flawed, biased, or unprofessional information sources. Unfortunately, such sources are plentiful on the Internet. This is why both professionals and non-professionals must be able to differentiate between factual and non-factual resources.
Specifically, factual resources provide reliable facts presented objectively. Their point is to inform and promote health literacy regarding specific topics. At the same time, non-factual sources contain biased and subjective information such as an opinion of an unqualified individual. The purposes of such resources could vary; for example, they could popularize myths for the sake of propaganda and in support of various social movements. Such sources can distort reality and may abuse facts to produce the desired effect and unfairly persuade readers.
To demonstrate how factual and non-factual sources work, two examples of websites that overview gender dysphoria will be explored. The first example is a factual website – Psychology Today. This is an online portal of a magazine that has existed since 1967. The articles in this magazine are created by qualified contributors who are renowned academics, psychiatrists, and psychologists. Many of the contributors have either M.D. or Ph.D. The article that introduces DG presents the condition in a non-personal manner providing a definition and listing symptoms for children and adults. The information provided is taken from DSM 5 that is a reliable scientific resource (“Gender dysphoria,” 2017).
The second example is a non-factual website called Gender Analysis. This website was created by Zinnia Jones, an average activist who does not have any kind of medical education or qualification. At the very beginning of her article overviewing GD, Jones (2017) informs her readers that she does not carry a medical degree and her writing is not intended as medical advice. Practically, the presentation of GD is based on the subjective experiences of the author and her friends. Moreover, Jones provides her classification of the disorder subdividing it into direct and indirect forms with her lists of symptoms.
Discussion of the Two Websites
As specified by Turban, Winer, Boulware, VanDeusen, and Escandela (2017), when it comes to GD, medical professionals are very careful regarding its diagnosing. In particular, according to the instructions presented in DSM 5, the symptoms of GD have to manifest consistently for at least six months for the disorder to be diagnosed. However, in the article by Jones (2017), there is no such information; instead, the author states that the disorder is different for everyone and can even exist “indirectly”. The author generalizes the condition making it look like it is common and has a multitude of forms. Puskaric, Helversen, and Reiskamp (2018) note that socially transmitted information, such as the one contained in the article by Jones, can impact public perceptions of various conditions, producing negative effects that occur in the forms of harmful myths, stigma, stereotypes, fears, and misinterpretation.
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Bressert, S. (2017). Gender dysphoria symptoms. Web.
Gender dysphoria. (2017). Psychology Today. Web.
Glidden, D., Bouman, W., Jones, B., & Arcelus, J. (2016). Gender dysphoria and autism spectrum disorder: A systematic review of the literature. Sexual Medicine Reviews, 4(1), 3-14.
Jones, Z. (2017). “That was dysphoria?” 8 signs and symptoms of indirect gender dysphoria. Web.
Nota, N. M., Kreukels, B., Heijer, M., Veltman, D. J., Cohen-Kettenis, P. T., Burke, S. M., & Bakker, J. (2017). Brain functional connectivity patterns in children and adolescents with gender dysphoria: Sex-atypical or not? Psychoneuroendocrinology, 18(86), 187-195.
Puskaric, M., Helversen, B., & Reiskamp, J. (2018). How social information affects information search and choice in probabilistic inferences. Acta Psychologica 182, 166–176.
Turban, J. L., Winer, J., Boulware, S., VanDeusen, T., & Escandela, J. (2017). Knowledge and attitudes toward transgender health. The Clinical Teacher, 4, 1-5.
Zucker, K. J., & Lawrence, A. A. (2009). Epidemiology of gender identity disorder: Recommendations for the Standards of Care of the World Professional Association for Transgender Health. Journal International Journal of Transgenderism, 11(1), 8-18.