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Models of Psychopathology in Children and Adolescents with Gender Dysphoria

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Gender Dysphoria and Disorders of Sex Development

Part of the book series: Focus on Sexuality Research ((FOSR))

Abstract

This chapter reviews empirical data on the extent to which children and adolescents with gender dysphoria show other types of psychopathology or behavior problems. It then reviews several models that have attempted to account for this psychopathology when it is present. Several factors have been reasonably established as accounting for at least some of the variance in general psychopathology, including peer social ostracism, cultural factors, and generic risk factors for psychopathology in the family. Surprisingly, little empirical attention has been given to the possibility that gender dysphoria is inherently distressing and thus is another source of the socioemotional problems that children and adolescents with this diagnosis experience.

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Notes

  1. 1.

    By models of psychopathology, we are not referring to the theoretical and philosophical discourse on whether or not GD per se is a type of psychopathology warranting classification as a psychiatric disorder. On this point, Meyer-Bahlburg (2010) provided a detailed analysis of the issue during the literature review phase of the DSM-5 process.

  2. 2.

    The CBCL and the YSR have two specific items pertaining to cross-gender behavior: “Behaves like opposite sex” or “I act like the opposite sex” (Item 5) and “Wishes to be of opposite sex” or “I wish I were of the opposite sex” (Item 110). The TRF has only the corresponding Item 5. In addition to these items, it is not unusual for parents to endorse other items on the CBCL that reflect cross-gender identification. For example, a parent might endorse “Strange ideas” (Item 85) and then provide an example such as “He wants to die and come back as a girl.” Youth may also make reference to gender issues on certain YSR items. In most of the studies reported on in Table 9.1, these items were scored as 0 to avoid any artificial inflation of the general behavioral disturbance indices. In Coates and Person (1985), however, it is unlikely that this procedure was followed. Thus, their percentage of clinical range cases may have been somewhat elevated because of this.

  3. 3.

    There are several sources from which one can examine informant agreement on the CBCL, TRF, and YSR in the North American standardization samples (Achenbach, 1991, Tables 5–3, 5–4, 11–1, pp. 62, 64, 182; Achenbach & Edelbrock, 1983, Table 6–2, p. 45; Achenbach & Edelbrock, 1986, Table 4–3, p. 37; Achenbach & Edelbrock, 1987, Tables 7–1, 7–2, 7–3, pp. 108–109, 111). Across all of these comparisons, correlations for the three indices of behavioral problems (internalizing, externalizing, and total) ranged from 0.31 to 0.75.

  4. 4.

    Green’s study was conducted prior to the introduction of the GID diagnosis for children in DSM-III. Many of the boys in his study would probably have met the criteria for GID.

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Authors and Affiliations

  1. Gender Identity Service, Child, Youth, and Family Program, Centre for Addiction and Mental Health, Intergenerational Wellness Centre, Beamish Family Wing, 80 Workman Way, Toronto, ON, M6J 1H4, Canada

    Kenneth J. Zucker Ph.D., Hayley Wood Ph.D. & Doug P. VanderLaan Ph.D.

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Correspondence to Kenneth J. Zucker Ph.D. .

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Editors and Affiliations

  1. Center of Expertise on Gender Dysphoria, Department of Medical Psychology, VU University Medical Center, ...., Amsterdam, 1007 MB, Netherlands

    Baudewijntje P.C. Kreukels

  2. Center of Expertise on Gender Dysphoria, Department of Medical Psychology, VU University Medical Center, Amsterdam, 1007 MB, Netherlands

    Thomas D. Steensma

  3. Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psych, VU University Medical Center, P.O. Box 7057, Amsterdam, 1007 MB, Netherlands

    Annelou L.C. de Vries

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Zucker, K.J., Wood, H., VanderLaan, D.P. (2014). Models of Psychopathology in Children and Adolescents with Gender Dysphoria. In: Kreukels, B., Steensma, T., de Vries, A. (eds) Gender Dysphoria and Disorders of Sex Development. Focus on Sexuality Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-7441-8_9

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