Another ethical fight is brewing on the transgender front. Lisa Littman, of the Brown University School of Public Health, has published the first serious study of “rapid-onset gender dysphoria” (ROGD) in PLOS One. This is a condition in which gender dysphoria suddenly appears in puberty or even after its completion. This runs contrary to the current model of gender dysphoria, which assumes that it is present from a very early age. Unsurprisingly, its opponents claim that ROGD does not exist and that Littman’s research is “biased junk science”.
Dr Littman attributes ROGD, in part, to social contagion, as it appears to occur in clusters and is associated with depressive symptoms, such as disordered eating, aggression, bullying, and drug use.
Ethical problems emerge in treatment for ROGD, as they do for early-onset gender dysphoria. But in the case of very young children, psychologists assume that the condition is present from birth and fundamentally immutable. In the case of ROGD, there is a strong possibility that it is a passing fancy.
More than 80% of parents said that their child’s announcement of being transgender came “out of the blue without significant prior evidence of gender dysphoria.” Shouldn’t their testimony be taken into account? Some psychologists discount input from parents and treat the adolescents as if they had standard gender dysphoria. This seems unwise, suggests Dr Littman, as many websites give advice to adolescents about how to fake their symptoms and how to construct a narrative consistent with life-long gender dysphoria.
“The findings that the majority of clinicians described in this study did not explore trauma or mental health disorders as possible causes of gender dysphoria or request medical records in patients with atypical presentations of gender dysphoria is alarming,” she writes.
When an AYA presents with rapid-onset gender dysphoria it is incumbent upon all professionals to fully respect the young person’s insider perspective but also, in the interests of safe diagnosis and avoidance of clinical harm, to have the awareness and humility themselves to engage with parental perspectives and triangulate evidence in the interest of validity and reliability.
An earlier statement of Littman’s views was dismissed in The Conversation by two Canadian academics, who insisted that psychologists are eminently trustworthy:
Transgender children are in good hands. Therapists aren’t acting hastily in ignorance of scientific evidence. On the contrary, their approach is one that’s been built over decades of research and of following trans children. The unfounded idea of rapid-onset gender dysphoria is a poor attempt at manufacturing a new moral panic — based on the same old idea of “contagion” — over children who couldn’t be in safer hands.
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