Gender Identity The "Rapid Onset Gender Dysphoria" Controversy What to Know About the Controversial Paper By Ariane Resnick, CNC Ariane Resnick, CNC Facebook Ariane Resnick, CNC is a mental health writer, certified nutritionist, and wellness author who advocates for accessibility and inclusivity. Learn about our editorial process Updated on December 01, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print DBenitostock / Getty Images Table of Contents View All Table of Contents What Is "Rapid Onset Gender Dysphoria?" Negative Impact of the Paper Pushback From Psychiatric Professionals Where the Term Stands Now Gender dysphoria is a term that many of us are still learning about and gaining understanding of. So when a researcher published a paper that undermined much of what advocates for transgender rights strive to help the general population understand and accept, it caused quite a stir. Ahead, we will examine the controversial work and its impact on transgender and gender diverse individuals and families. What Is "Rapid Onset Gender Dysphoria?" The term "rapid onset gender dysphoria" was presented in a paper by Brown University's Lisa Littman, MD, MPH, in 2018 in a journal called PLOS One. Littman wrote the paper as if rapid onset gender dysphoria were an actual condition, but it wasn't based on studies, or even facts. What the Paper Claimed Littman's claim was that around the time of adolescence, children were becoming dysphoric about their gender suddenly as a result of peer pressure and social media, and using that dysphoria as a coping mechanism. She postulated that gender dysphoria was like anorexia for teen girls, and wasn't an actual medical condition, which it is, so much as a cultural and temporary response to the difficulties of puberty. She also claimed that these children had not been transgender prior to puberty. In the article, Littman defined rapid onset gender dysphoria as "a type of adolescent-onset or late-onset gender dysphoria where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood." She made this claim based on anecdotal "evidence" from parents of children and teenagers, not from clinical research. As nearly 2% of youth identify as trans, this claim affected a substantial portion of the population. The paper did not take into account the fact that it's normal and common for children to keep sensitive information to themselves, and to present it to their parents when they feel ready. By framing the fact that children may not tell their parents about their dysphoria until they're in the pre-pubescent stage, Littman discounted the very simple way that humans of all ages deal with complex emotions: by expressing them when they are ready to. While having the support of peers who are also expressing similar emotions may lead a child to feel more safe telling their own family about their dysphoria, there is no technical or real relationship between seeing other children share about dysphoria and claiming to feel it oneself. The Harm of Claiming "Rapid Onset Gender Dysphoria" Is Real Advocacy for trans rights is still in its youth, and many people remain unaware of the struggles that transgender, gender non-conforming, and other gender diverse people face on a daily basis. There are numerous anti-trans rights bills in the legislature, and transgender and gender-nonconforming people are targeted for hate crimes regularly. Because there is still so far to go for trans people to have the human rights all people deserve, a published claim that gender dysphoria occurs as the result of social media and peer pressure, and is not an actual medical condition, does a grave disservice to the movement for trans rights. In addition to doing damage to advocacy for trans rights on a large scale, claiming that teenagers and pre-teens are not actually experiencing a very real medical condition can prevent them from getting the treatment they need and deserve. This can affect countless children who might otherwise get the appropriate medical and psychiatric care for their condition. Puberty is the time when medical intervention becomes necessary. Hormone blockers stop the progression of changes that would otherwise occur, and that intervention leads to a higher survival rate of the children who receive it. Transgender youth are more likely to suffer from depression than their cisgender peers. In fact, 1 in 3 have reported attempting suicide. When trans youth experience parental support, though, they are more likely to be healthy individuals. That health encompasses everything from self-esteem to adequate food supply. That means that how parents feel about their child being trans, and how they deal with it, has a huge impact on the well-being, and the very survival, of their children. Parents who don't think their child's gender dysphoria is real would be unmotivated to get their child the needed medical care that would then lead to higher survival rates, making Littman's paper a dangerous and harmful work to the lives of countless children. Pushback From Psychiatric Professionals Luckily, the psychiatric industry didn't take kindly to Littman's paper. Within months of the paper's release, PLOS One published a "corrected" version of it, which addressed the many concerns being brought up over the unscientific nature of the article. This version acknowledged that the term "rapid onset gender dysphoria" was just the author's hypothesis, not an actual diagnosis, and that the idea was based on anecdotal evidence, not scientific research. However, the "corrected" version still made the same claims, and there was still much outrage. WPATH, which stands for The World Professional Association of Transgender Health, was the most directly relevant authority organization that spoke out against the article. Because WPATH creates the standards of care used for transgender medical care, the medical and psychiatric industries listened when they published their rebuttal. WPATH clearly stated that they advocate for science-backed and evidence-based literature to be used when theorizing about transgender issues and considering medical treatment for trans patients. The organization also noted that the term could be used to instill fear in treating trans patients, which can cause lifelong harm to them. Considering the importance of hormone blockers during puberty, pushing parents to question their children's authenticity about their own medical condition could be seen as an attempt to block access to care at a vital time. Others in the research community worked to upend the claims made by Littman. A fellow of Littman's at Brown University named Arjee Javellana Restar published a response to the piece entitled "Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of 'Rapid-Onset Gender Dysphoria.” Restar notes that "in Littman’s case, the majority of methodological and design issues stem from the use of a pathologizing framework and language of pathology to conceive, describe, and theorize the phenomenon." This was a similar viewpoint to WPATH, stating that there was no ground to present anecdotal evidence as science-based. Where the Term "Rapid Onset Gender Dysphoria" Stands Now After being thoroughly debunked, the concept of "rapid onset gender dysphoria" did not make it further into the mainstream. That said, it can still be accessed and still exists on the internet. When parents are told by their child about their gender dysphoria, the "corrected" version of the article, may be something they come across. By keeping something that appears to be scientific research, but actually isn't, out in the world, further harm can be caused. If a parent looking to understand their child's dysphoria is surprised by it, they could resonate with Littman's claims about the child's dysphoria being temporary and not real, but rather a coping mechanism caused by peer pressure or social media. There is currently no major movement to remove Littman's article from publication, so it remains up to parents to do their own research if they choose to read it. A Word From Verywell Getting your child the proper care for gender dysphoria may be a lifesaver. While there is much misinformation on the internet about it, gender dysphoria is a real medical condition that is acknowledged in the DSM 5, and it can be diagnosed and treated by a medical professional. 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS One. 2018 Aug 16;13(8):e0202330. The Trevor Project. Data on Transgender Youth. Published February 22, 2019. Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics. 2020 Feb;145(2):e20191725. Littman L. Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS One. 2019 Mar 19;14(3):e0214157. Restar AJ. Methodological critique of littman’s (2018) parental-respondents accounts of “rapid-onset gender dysphoria.” Arch Sex Behav. 2020 Jan 1;49(1):61–6. 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