Understanding Gender Dysphoria in Adolescence: Identity, Distress, and Mental Health Outcomes

How can one imagine how it will feel to be called by names or pronouns that do not suit the person in question every time they are referred to? Many adolescents go through such  situations that lead to them feeling nervous or tense constantly due to their unconventional gender identity (Tordoff et al., 2022; Meyer, 2003) 

Identity formation is especially important for teenagers since it is the period of life when young individuals first learn about their inner world (Erikson, 1968). Many young people tend to experiment with their identity by experimenting with different aspects of their personality. However, there are instances where the exploration process may result in a feeling of disparity between one’s view of oneself and actual biological gender identity.

Whenever such a disparity causes a lot of distress, it can lead to gender dysphoria (APA, 2022). Gender dysphoria should be understood because having an enabling environment is a great advantage for adolescents, who can easily deal with this issue. This essay will try to identify factors causing gender dysphoria, its symptoms, and the negative impact on one’s mental health. And the significance of providing support to teenagers affected by gender dysphoria. 

Understanding Gender Dysphoria and Identity Development 

Gender identity refers to an individual’s inner sense of their gender (World Health Organisation [WHO], 2019). Gender identity development involves numerous psychological and social components. Adolescence is a period during which significant changes in the body occur, together with increasing awareness of oneself. Consequently, people tend to explore more aspects of their identity (Erikson, 1968). 

Discomfort caused by the mismatch between gender identity and biological sex constitutes the essence of gender dysphoria and is characterised by marked disturbances in social functioning  (APA, 2022). It should nonetheless be stressed that gender diversity per se does not constitute a disorder; nevertheless, the discomfort experienced by people suffering from gender dysphoria should still be studied (WHO, 2019). 

Currently, researchers focus on the reasons for gender identity formation. Prenatal hormones, genes, and the brain play key roles in gender identity formation (Rosenthal, 2021). In addition, perception of one’s gender identity may also depend on psychological and social determinants (Coleman et al., 2022). However, no single factor has ever managed to account for gender dysphoria formation in its entirety. One of the most difficult periods in the lives of those suffering from gender dysphoria is puberty, during which individuals’ secondary sexual characteristics emerge (Steensma et al., 2013). As a result, individuals develop more discomfort in addition to existing problems. Moreover, it contributes to greater psychological distress along with low self-esteem, poor communication skills, and mental problems (Rosenthal, 2021).

Read More: How To Overcome Low Self-Esteem? 

Identification of the Signs and Symptoms of Gender Dysphoria 

The symptoms of gender dysphoria usually differ from one adolescent to another. Some adolescents may face milder forms of discomfort. On the other hand, some may experience intense symptoms that disrupt their day-to-day functioning (APA, 2022). Symptoms of gender dysphoria are:

• Discomfort due to physical attributes such as primary or secondary sexual traits (APA,  2022).  
• A desire to be recognised as well as addressed in the manner associated with the other gender (APA, 2022).  
• Intense distress due to the usage of an individual’s birth name and pronouns. These are inconsistent with one’s true gender (Coleman et al., 2022).  
• Aversion towards one’s reflection in pictures or mirrors (Rosenthal, 2021).  
• Wishing to possess the sexual characteristics associated with the other gender (APA,  2022).  

Puberty and physical development (Steensma et al., 2013). It is of significant importance to notice early symptoms because they minimise the risk of future problems (Rosenthal, 2021).  Apart from anxiety, confusion, frustration, sadness, and loneliness have also been reported as some of the symptoms experienced by teenagers experiencing gender dysphoria (Turban et al., 2020).

The appearance of all these symptoms is explained by psychological stress experienced due to being rejected by both family and society members (Meyer, 2003). It is necessary to note that seeking the establishment of personal identity has turned into a top priority for youth  (Erikson, 1968). It is worth mentioning that a gender identity crisis does not necessarily lead to gender dysphoria. In such cases, the issue needs to be studied thoroughly.  

Read More: Is Gender Dysphoria Associated With Paranoia in Patients?

Family Support, Sociocultural Issues, and Psychological Well-Being-

About the psychological well-being of people with a transgender identity concerning the above problems, sociocultural issues become highly important (Meyer, 2003). In this regard, there is much evidence provided by scholars according to which family support is an extremely important component of the psychological well-being of such youth. But many adolescents who are considered to be gender diverse have to undergo the experience of rejection, confusion, discrimination, and even bullying owing to their gender (Johns et al., 2019). In this context, these kinds of experiences contribute to the formation of emotional challenges in them.  

Anxiety, or a condition characterised by worry, fear, and nervousness that affects one’s functionality, is common among gender-diverse adolescents (National Institute of Mental Health [NIMH],  2023). Depressive mood, or persistent experience of sadness, lack of motivation or enthusiasm, and indifference, is a frequent issue among gender-diverse adolescents (NIMH, 2023; Tordoff et al., 2022). 

It was revealed that, compared to their cisgender peers, gender-diverse youth, and more specifically transgender individuals, suffer from depression, suicidal behaviour and ideation, and experience anxiety on a higher scale (Tordoff et al., 2022). Nevertheless, research suggests that how society treats transgender teenagers largely drives these difficulties (Meyer, 2003). Bullying remains a serious obstacle to personal safety, academic success, and overall well-being (Johns et al., 2019). Verbal abuse, cyberbullying, exclusion, and physical violence can cause stress and loneliness (Meyer, 2003). 

On the contrary, it has been found that supportive attitudes of parents, friends, and educational institutions lead to fewer instances of depression and suicide attempts among gender-diverse teenagers (Ryan et al., 2010; Turban et al., 2020). 

The Role of Supportive Mental Health Care 

Intervention for mental health is crucial in helping young people cope with gender dysphoria in terms of emotional regulation and exploration of identities (Coleman et al., 2022). In this regard, psychological services are offered to ensure the wellness and resilience of patients by tackling any traumatic experience they may be going through while leaving their gender identity unaffected (Coleman et al., 2022).

Individual counselling, family therapy, psychoeducation, and peer support therapy are some of the intervention methods that may be administered to young people by professionals in the field of psychology (Coleman et al., 2022). Family therapy helps parents and families better understand the gender-related challenges their children face (Ryan et al., 2010).

Affirmative therapy aims at validating an individual’s gender identity and providing a platform where they will openly talk about their emotions, thoughts, and future aspirations (American Psychological Association, 2021). It has been shown from empirical evidence that this strategy ensures greater well-being and lowers the risk of suicidal attempts, anxiety, and depression among gender diverse and transgender youth (Tordoff et al.,2022 

Educational institutions play an important role in promoting positive mental health among teenagers. This happens through practices such as inclusion, bullying prevention programs, respect for students from teachers, and the use of appropriate names and pronouns by teachers. Teenagers who consistently receive positive reinforcement from their family members, schools, medical practitioners, and communities can achieve self-respect, confidence, and positivity in their minds (Ryan et al., 2010). 

Conclusion

Gender dysphoria encompasses more than problems of identity, impacting the emotional state of the adolescent population (APA, 2022). The stress associated with incongruence between one’s natural gender and the perception of that person’s gender by society can lead to various negative consequences, such as anxiety, depression, social isolation, and even disability, particularly in the case of adolescents who experience discrimination and ostracisation (Meyer, 2003; Tordoff et al., 2022).

As it was discussed above based on literature data, having an environment that supports the idea that it is okay to be oneself and that one can get along well with other people is important for the psychological health of gender-diverse adolescents (Ryan et al., 2010; Turban et al., 2020).

Families and schools should therefore welcome and support them. Furthermore, schools and families must provide psychological support and address bullying and harassment (Johns et al., 2020). In view of the growing significance of this issue, it has become necessary to understand gender dysphoria. One should do more than accept people, but also promote their mental and physical development. 

References +

• Arcelus, J., Bouman, W. P., Van den Noortgate, W., Claes, L., Witcomb, G., &  Fernández-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30(6), 807–815.  https://doi.org/10.1016/j3europsy.2015.04.005(open in a new window) 
• Bigler, E. D. (2013). Traumatic brain injury, neuroimaging, and neurodegeneration.  Frontiers in Human Neuroscience, 7, 395. https://doi.org/10.3389/fnhum.2013.00395 
• Chen, M., Fuqua, J., & Eugster, E. A. (2016). Characteristics of referrals for gender dysphoria over 13 years. Journal of Adolescent Health, 58(3), 369–371.  https://doi.org/10.1016/j.jadohealth.2015.11.010 
• Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames,  D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R.,  Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., . . . Mukadam,  N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. https://doi.org/10.1016/s0140- 6736(24)01296-0 
• Oklahoma State Legislature. SB 129 by Bullard and West (Kevin). Accessed  June 10, 2024. http://www.oklegislature.gov/BillInfo.aspx?Bill=sb129 
• Pocai, B. (2019). The ICD‐11 has been adopted by the World Health Organisation. World  Psychiatry, 18(3), 371–372. https://doi.org/10.1002/wps.20689 
• Harlow AF, Lundberg D, Raifman JR, et al. Association of coming out as lesbian,  gay, and bisexual+ and risk of cigarette smoking in a nationally representative sample of youth and young adults. JAMA Pediatr. 2021;175(1):56-63. doi:  10.1001/jamapediatrics.2020.3565 [DOI] [PMC free article]