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Gender Dysphoria in Childhood: The Challenges and the Solution



Gender is one part of a person’s identity, and it comes with several social and cultural standards. These can be in how people dress, how they talk, what activities they do, and more. Many people would align with the gender they were assigned with at birth, but some may feel that they don’t identify with their assigned gender, leading to distress. This feeling is called gender dysphoria, and it can develop as early as childhood.

 

Gender Dysphoria for Children


According to the DSM-V, gender dysphoria (GD) is officially defined as a “marked incongruence between one’s experiencedor expressed gender and assigned gender” (Ristori & Steensma, 2016, pg. 13). This incongruence can cause clinically significant distress and impair children’s functioning in their daily lives. Children with GD may behave differently, such as in how they play or dress, compared to that of their assigned gender in enduring ways to align with their experienced gender.

 

In order to diagnose GD in children, their feelings of incongruence must have lasted for at least six months, and they should exhibit six out of the eight following criteria with one of them being the first (Ristori & Steensma, 2016):


  • Strong desire to be of another gender or insistence to be another gender;

  • Dislike of one’s sexual anatomy;

  • Desire for the primary or secondary sex characteristics of another;

  • Preference for cross-dressing;

  • Adopting cross-gender roles in fantasy play;

  • Strong preferences for toys, games, or activities of another gender;

  • Preference for playmates of other gender; and

  • Strong aversion or rejection of typically gender congruent roles, interests, preferences, and behaviors.

 

How Does Gender Dysphoria Persist?


In some cases, GD can desist early on in childhood, but in others, it can last even beyond adolescence. There are several factors that can contribute to its persistence later in life. The intensity of GD and the amount of gender-variant behaviors during childhood are some factors - the more distressful the GD and the more observed gender-nonconforming behaviors, the more likely it is to persist. Social transitions during childhood, such as changing pronouns or one’s appearance, also account for the persistence of GD (Steensma et al., 2013). Furthermore, early adolescence, or year 10 to 13, is a critical period in the persistence or desistence of GD. Developments during this period, such as bodily changes from puberty, first experiences of love and attraction, and changes in social environment made children more aware of their increased or decreased feelings of incongruence with their gender (Ristori & Steensma, 2016).

 

How Does Gender Dysphoria Affect Children?


GD can have several harmful effects on a child’s mental health. Besides feeling clinically significantly distressed, children may experience many internal psychological problems such as anxiety, depression, social withdrawal, and suicidal behaviors. These can leave them more psychologically vulnerable to stressors like their current distress from the dysphoria and social stigma. Additionally, gender-nonconformity can increase social intolerance and worsen peer relationships because of the stigma against it. These factors can intensify the psychological problems caused by GD (Claahsen-van der Grinten et al., 2021; Ristori & Steensma, 2016).

 

Addressing GD in Children: Psychologically and Physically


In order to treat GD, efforts should be focused on reducing distress and psychological problems related to the GD while helping them adjust and prepare them for the future. Mental health professionals and practitioners should work with both the parents and child to address GD. Furthermore, it’s important to note that the family’s situation, beliefs, behaviors, and other related factors should be accounted for when designing a treatment approach.

 

The following are strategies both families and practitioners can try to desist GD (Claahsen-van der Grinten et al., 2021; Ristori& Steensma, 2016):


  • Create a safe space for children to explore and be open with their identity, especially with their feelings on their gender.

  • Find a balance between a supporting and a realistic attitude towards GD to protect the child towards GD’s development.

  • Provide psychoeducation to the family to teach them about gender expression and development and to assist them in decision making.

  • Address co-existing problems in the family such as parents’ mental well-being and other mental health disorders.

  • Assist the child in building a positive self-identity and gender resilience by affirming their gender identity.

 

Some families may consider medical interventions to help the child align more with their gender identity. These can include pubertal suppressions, gender-affirming hormonal treatment, or gender-affirming surgery (Claahsen-van der Grinten et al., 2021). However, it can be risky to use these methods since there is no guarantee GD will desist afterwards, plus it may be difficult or more costly to physically retransition again. Families should consult with professionals and consider their circumstances in order to make proper decisions regarding medical treatments and prepare for any future developments.

 

Overcoming GD can be a big challenge for both the child and the family as there are many factors and issues to consider. However, with proper support and care, children can have a healthy gender exploration and development to combat the distress that comes with GD and flourish into their true selves.

 

We at Fidecita wish you the best in your mental health endeavors. Click here to know more about Fidecita HR Advisory’s Mental Health Care services.


 


References:


Claahsen-van der Grinten, H., Verhaak, C., Steensma, T., Middelberg, T., Roeffen, J., & Klink, D. (2021). Gender incongruence and gender dysphoria in childhood and adolescence – current insights in diagnistics, management, and follow-up. European Journal of Pediatrics, 180, 1349-1357. https://doi.org/10.1007/s00431-020-03906-y


Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28(1), 13–20. https://doi.org/10.3109/09540261.2015.1115754


Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. https://doi.org/10.1016/j.jaac.2013.03.016

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