The Myth of Rapid-Onset Gender Dysphoria Label and How It Hurts Teens

Medical-Sounding Phrase Used to Invalidate Teen Trans Experience

If you’re the parent of a middle-school or high school student, you’ve probably noticed there are more kids who identify as LGBTQI+ than when you were in middle school or high school. Among these teens exploring their identity on their journey through puberty to adulthood, you may notice a distinct increase in the number of pre-teens and teens who identify as transgender, non-binary, or questioning.

We’re parents, and we’ve noticed the same thing.

When we notice these things, we need to be very careful about our internal and external responses. A knee-jerk reaction that harms our kids goes something like this:

“They’re just playing at all this stuff for attention or to rebel against their parents. It’s just a new version of teenage differentiation. If they didn’t have all these choices – all these new letters like L, G, B, T, Q, and I, then they probably wouldn’t go down this road.”

Let’s be clear: if you think that, we encourage you to examine those thoughts and reassess your conclusions. When an LGBTQI+ teen hears something like this – particularly a trans teen who feels deep in the core of their being that they are not the gender assigned them at birth – they feel devalued, invalidated, talked down to, and, in a word, insulted.

We know because we work with and talk to transgender kids every day. Some of us have transgender kids ourselves, and our kids who are not transgender most certainly know transgender teens from school, around the neighborhood, or from extracurricular activities.

Our job is to love and support these young people and give them the tools they need to be the best version of themselves.

However, there’s a group of adults – including some mental health professionals –  who seek to leverage the language of science to further marginalize this group of young people. To that end, they attempted to create a new diagnosis: Rapid Onset Gender Dysphoria (ROGD).

What is Rapid Onset Gender Dysphoria?

Let’s be one hundred percent clear on this:

ROGD is not a real mental health disorder. No such diagnosis exists in the Diagnostic and Statistical Manual of Behavioral Disorders, Volume 5, which is the official reference used by mental health professionals to diagnose mental illness and mental health disorders.

We’d love to end this article right here, with that simple statement of fact. However, since the stigma against transgender people, gender-affirming therapy, and teens in the process of exploring their trans identity is still a powerful force in our culture, we’ll take the time to explain the origin of this theoretical diagnosis and debunk the claims upon which advocacy for its official recognition are based.

First, though, here’s how those who claim ROGD is a real diagnosis define ROGD:

ROGD is distinct from traditional presentations of gender dysphoria such as early-onset and late-onset gender dysphoria. Those who meet the criteria for ROGD are adolescents and young adults with no prior indication of gender dysphoria who identify as transgender. ROGD in these adolescents and young adults is attributable to social influences, exposure to transgender information online, and maladaptive coping mechanisms.

That’s what the phrase means.

Now let’s have a look at where it came from.

The Origin of the Phrase “Rapid Onset Gender Dysphoria”

In August 2020, author, researcher, and bioethicist Florence Ashley published an article called “A Critical Commentary On ‘Rapid-Onset Gender Dysphoria’.” This article examines the genesis of the proposed ROGD diagnosis and offers a commentary on each category of evidence proponents of the ROGD diagnosis claim support its validity. We’ll use this critical commentary as our primary source of information for the rest of this article.

The first mention of ROGD appears around 2016 in websites that are openly hostile to transgender people and the transgender experience, such as 4thWaveNow, Transgender Trend, and YouthTransCriticalProfessionals. The last site is now private and inaccessible to the general public. The phrase achieved widespread notoriety with the publication of a research paper called  “Rapid-Onset Gender Dysphoria In Adolescents And Young Adults: A Study Of Parental Reports.”

The title of that article reveals the primary flaw of the study. The author, Dr. Lisa Littman, recruited parents only for the study, and only recruited parents through these websites. Here’s an excerpt from a blog post from 2016 in which Dr. Littman seeks parents for her study:

“We have heard from many parents describing that their child had a rapid onset of gender dysphoria in the context of increasing social media use and/or being part of a peer group in which one or multiple friends has developed gender dysphoria and come out as transgender during a similar time frame. If your child has had sudden or rapid development of gender dysphoria beginning between the ages of 10 and 21, please consider completing the following online survey.”

Dr. Littman recruited 256 parents from the three websites we identify above to conduct the study, which first appeared in the journal PLOS, published by Brown University, in August 2018. It’s important to recognize that Dr. Littman included neither transgender adults nor transgender adolescents or young adults in the survey, the subsequent statistical analysis, or the publication itself.

That’s a major red flag: a study about trans people that does not include the direct input of any trans people.

It’s also critical to recognize that the participants were recruited on websites that cater to parents who are openly hostile to transgender people. That’s another red flag, which indicates the likelihood that the results of the survey – and any subsequent analysis – are influenced by what’s known as confirmation bias.

Brown University Revises and Republishes the Study

In addition to those structural problems, the content of the study itself caused controversy. Two days after publication, Brown University removed mention of the paper from its press releases, and within two weeks, announced that the editorial staff would review the paper. They did, and republished it a year later, with close to three thousand words of disclaimers and clarifications, a new title, and an expanded discussion and explanation of the conclusions reached from statistical analysis.

We provide a link to the original study with the original title above. Here’s a link to the republication, with the new title “Parent Reports Of Adolescents And Young Adults Perceived To Show Signs Of A Rapid Onset Of Gender Dysphoria.”

And here’s a link to the correction announcement, with its three thousand words of explanation. We encourage you to read the extensive commentary:

Correction: Parent Reports Of Adolescents And Young Adults Perceived To Show Signs Of A Rapid Onset Of Gender Dysphoria.”

We understand: we’re throwing a lot of links at you. It’s a lot to follow. But if you have an LGBTQI+ pr trans teen or child, this information matters to both you and your child.

The story of this paper is important to us, because when research appears that can cause harm to the teens we support with love and compassion every day, we feel the need to add our experience to the discussion. And when research appears about trans teens, who fight an uphill battle every day just to be themselves, we feel the need to validate their experience not only with our personal clinical observations, but with an abundance of evidence that dispels stigma, refutes unfounded claims, and sets the record straight on the wealth of misinformation online and in our culture about the LGBTQI+ community in general, and the trans community in particular.

We’ll end this section with the words of Dr. Diane Ehrenshaft, Director of the Child and Adolescent Gender Center Clinic at the University of California. Interviewed in Science Magazine in 2018, Dr. Ehrenshaft said:

“I would have rejected this manuscript outright for its methodological flaws and also its bias. [The implication that] gender exploration is simply a fad whipped up by peer influence [should not be taken as authentic]. It negates the experience of many transgender youth.”

For the rest of this article, we’ll use information from “A Critical Commentary on Rapid Onset Gender Dysphoria” to explain why a professional like Dr. Ehrenshaft would have rejected the ROGD paper, and why mental health professionals and parents of trans teens should believe us when we say ROGD is not a real diagnosis.

Deconstructing the Proposed ROGD Diagnosis

The first RODG paper offers several explanations for the necessity of creating a new category of mental disorder, as distinct and separate diagnosis from existing DSM-V categories related to gender dysphoria.

Claim 1: ROGD is different than late-onset gender dysphoria.

The rationale behind the claim:

Proponents of ROGD assert that there has been a sudden, rapid increase in teens presenting with dysphoria out of the blue without ever having expressed any gender variance before. ROGD proponents claim this was virtually unheard of until a few years ago and that the late onset of dysphoria merited the creation of the new class of disorder, ROGD.

The data that refute this claim:

First, the statistics from peer-reviewed journals related to age of onset of gender dysphoria contradict the ROGD claim that late-onset gender dysphoria is a new phenomenon:

  • 40% of trans adults begin to feel like they may not be cisgender at or after 11 years old
  • 19% report beginning feeling that way after 15 years old

Second, an interim period before the first feelings that a person might not be cisgender and coming out as trans, or non-cisgender is common. Therefore, the argument for ROGD on the basis of age does not have a solid evidentiary basis.

Finally, the DSM-V language around gender dysphoria and age of onset is clear:

“Late-onset gender dysphoria occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria”

(You can read a full online version of the DSM-V here. The above information is on p. 455.)

Claim 2: ROGD is caused by the contagion effect.

The rationale behind the claim:

Proponents of ROGD cite several reasons the contagion effect may explain ROGD. If you’ve never heard of the contagion effect, it is a real thing. You can read about it in our articles here and here. In a nutshell, the contagion effect describes mental illness/mental health conditions spreading among peer groups after exposure to information on a given set of behaviors, such as non-suicidal self-injury (NSSI), suicide, or risky behavior such as drug use. Proponents of ROGD say it may be caused by psychic contagion for the following reasons:

  • The increase in teens referred to gender identity clinics
  • The influence of LGBTQI+ peer groups on previously non-LGBTQI+ teens
  • LGBTQI+ content online
  • Social isolation

The data that refute these claims:

Statistics from a study that collected information from over a thousand teens referred to gender identity clinics contradict the claim in the first bullet point. Here’s what the study authors report:

  • Between 2000 and 2016, the percentage of referrals to gender identity clinics diagnosed with gender dysphoria remained statistically stable
  • The intensity of gender dysphoria among diagnosed individuals remained stable
  • The increase in total number of referrals to gender identity clinics most likely reflect a decrease in stigma around transgender identity

Claim 3: The appeal of transition lies in offering a quick solution for an underlying psychological distress rooted in mental illness.

The rationale behind the claim:

Anti-trans parents and activists claim that when youth identify as transgender, it’s a “a symptom of severe psychological pain or dysfunction” and an attempt to resolve “all unhappiness, anxiety, and life problems.” Therefore, what transgender kids need, as opposed to gender-affirming therapy in a mental health setting that supports their right to live the life of their choosing, is therapy to resolve the mental health issues that make them “mistakenly” identify as transgender.

To refute this claim, we do not need to mine the internet for relevant research and statistics.

Why?

Because this claim includes an assumption that pathologizes the trans experience, implies that the drive to identify as trans is rooted in mental illness or a mental health disorder, and that gender dysphoria itself is a pathology identical with identification as trans.

None of that is true.

For a diagnosis of gender dysphoria, a person who knows they were assigned the wrong gender at birth – a trans person, in other words – must experience “clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

What people who aren’t transgender and have no experience with trans people need to understand is that the stress associated with being transgender stems directly from stigma around trans people, and everything that stigma causes: judgment, nonacceptance, rejection by friends and family, ridicule, online and in-person bullying, emotional abuse, physical abuse, and, in some cases, hate crimes like assault. The stress and distress is related to being transgender, yes, but being transgender is not the cause of the distress: it’s the emotions related to the complexities of being transgender in a predominantly cisgendered world.

Transgender is an Identity, Not a Fad

It’s true that transgender people are more visible now than ever before. The same is true of the rest of the queer community, meaning the L, G, B, Q, and + members. However, this does not mean that gay people, lesbians, bisexual people, and queer people are new to the human race. They did not drop out of the sky after the sexual revolution in the 1960s. They did not magically appear when gay people started celebrating PRIDE month in a visible way in the 1980s, or after the Supreme Court recognized the legal validity of gay marriage in 2015.

Members of the LGBTQ+ community have been here all along. They’re not the majority, but that’s irrelevant. They’re here. They are members of our families and our extended families. We work with them and we go to school with them. We teach them. As friends, we support them. And when they’re our children, our job is to love them and give them the tools they need to be the best possible version of themselves.

As therapists, we help them, and we do not create diagnoses that risk marginalizing them and make their lives harder than they already are. That means when we see diagnoses like Rapid Onset Gender Dysphoria (ROGD) offered without a solid evidence base, we’re skeptical.

With regards to the term Rapid Onset Gender Dysphoria (ROGD), we concur with the conclusion Florence Ashley reaches in the critical commentary we cite in the beginning of this article:

“The term reflects a deliberate attempt to weaponize scientific-sounding language to dismiss mounting empirical evidence of the benefits of transition. ROGD theory is best understood as an attempt to circumvent existing research that demonstrates the importance of gender affirmation, relying on scientific-sounding language to achieve respectability.