Gender Dysphoria and Mental Health

Few things are more challenging than experiencing a discord between the gender you feel you are and the one you were assigned at birth. Adding to this complexity is the fact that a significant body of research is starting to reveal that transgender individuals face an uphill battle when it comes to mental health. Beyond the obvious challenges of dealing with gender nonalignment is another important consideration: determining whether the origin of those concerns is external (discrimination, stigma) or stemming from an internal cause such as gender dysphoria.

Gender dysphoria (also known as gender identity disorder) is characterized by definitive and persistent feelings of identification with the opposite gender. So much so that an individual experiences extreme discomfort with their assigned sex resulting in significant distress or impairment.  Identity issues manifest in a number of ways in private life and public interactions.

Researchers are working to uncover whether there is something biological and hormonal that may contribute to increased risk of mental health concerns in transgender individuals or if societal and environmental factors such as stigma and discrimination are to blame for the increased risk of emotional symptoms.

Transgender Adults Suffer More From Mental Health Disorders

A study published in JAMA Pediatrics examined mental health and substance dependence rates among 300 young transgender women. Researchers found that the rate of psychiatric disorders and substance abuse among these women was nearly two to four times greater than in the general population. Approximately 40% of the women reported a mental health or substance dependence disorder, and 20% were diagnosed with at least two psychiatric illnesses. More than one-third reported symptoms of depression and 1 in 5 reported that they had suicidal thoughts within the past 30 days. Results also showed that rates of post-traumatic stress, anxiety and alcohol abuse were all well above the average. A further burden on the study participants was the fact that most were unemployed and many lived in extreme poverty - factors that are known mental health stressors and which could be contributing factors towards stigmatization.

Importance of Gender Affirmation for Transgender Youth

In addition, a study conducted by the University of California Los Angeles finds that gender dysphoric youth in California were more than twice as likely to struggle with psychological disorders compared to those who conformed to their biological sex. According researchers, nearly 17% percent of participants who identified as gender non-conforming reported significant psychological distress versus only 7% percent of those who identified as gender conforming.

Those findings did not align with the results of a study published in Pediatrics that focused on transgender children who were affirmed in their new gender identities. This trial enrolled 70 transgender children ages 3 to 12, and researchers found that this younger subset did not experience any greater instances of depression, and only experienced slightly more anxiety than non-transgender children of the same age.

Why the difference? It seems the younger group was exposed to a significant degree of emotional support from their families. According to the study's lead author, Kristina Olson, assistant professor of psychology at the University of Washington, "these transgender children were affirmed in their gender identities in all aspects of their lives," through peer, parental, other social support. "A lot of the trauma that gender dysphoric children particularly experience is the lack of validation, the kind of ongoing, 'No, you're not what you say you are; you are what the church says you are and what your grandmother says you are and what the doctors say you are,' " Olson said.

On the whole, researchers agree that there is still much to learn on the subject. Overall it is clear that validation and acceptance reduce the risk for mental health concerns while stigma and discrimination may increase the risk.