Models of Psychopathology and Psychiatric Comorbidities in Children and Adolescents with Gender Dysphoria

Gender Dysphoria (GD), according to DSM-V, is a marked incongruence between the sex that one feels or expresses and the sex assigned at birth; causing clinically significant discomfort or impairment in social, occupational, or other important functioning areas. The previous term “Gender Identity Disorder” was replaced to avoid pathologizing identity. Not all gender-variant individuals experience gender dysphoria. Transgender person is an umbrella term used for identifying all those individuals who experience discordance or discomfort between natal gender and expressed gender. GD can adversely affect the daily life of a person in various ways. Experiencing disgust towards their own body or feeling another’s attention to their “wrong” gendered body may lead them to avoid social activities, sports, sexual encounters, etc. Understanding the various models of psychopathology helps in the clinical management of GD. If Stroller’s model is correct, the underlying systemic psychopathology and dynamics need to be addressed. In case of Coates and Person’s, resolution of separation anxiety is the target. In case of social ostracism model, therapeutic aim could be a reduction in the gender-variant behavior expressed by the child and taking measures to provide a safer social environment. In case of GD as an inherent cause of distress, treatment is focused on eliminating GD. Studies show increased rates of psychiatric morbidity in GD children and adolescents, including that of suicidality and self-harm, depression, and eating disorders when compared with their peers. Prevalence of psychiatric comorbidity among GD children increases with age; the most vulnerable period being adolescence. Various studies show that 58–71% of GD cases exhibit at least one psychiatric disorder, most frequently being depression (50%) followed by anxiety (37.2%) and self-harm (8%). Having awareness of risk of psychiatric comorbidities is essential for clinicians working with GD children.