Children with gender identity disorder are at serious psychiatric risk

February 22, 2012, Children's Hospital Boston

(Medical Xpress) -- The first study to characterize a cohort of U.S. children with diagnosed gender identity disorder, led by researchers at Children’s Hospital Boston, documents significant mental health risks as children struggle with strong feelings of being born “in the wrong body.” Findings appear in the March 2012 Pediatrics (published online February 20).

The study, led by endocrinologist Norman Spack, MD, at ’s Boston, in collaboration with attending psychiatrist Scott Leibowitz, MD, reviewed the charts of 97 consecutive patients who were seen at the hospital from 1998 through early 2010 and met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for gender identity disorder: a strong, persistent identification as being of the opposite sex (transgendered) and significant distress and discomfort with one’s biological sex.

Of these patients, who first came to Children’s Hospital Boston at an average age of 14.8 years, 44 percent had a history of psychiatric symptoms, 37 percent were taking psychotropic medications, 21 percent had a history of self-mutilation and 9 percent had attempted suicide.

Fifty-eight percent received a medical intervention. This consisted of opposite-sex hormones (to develop a physical appearance closer to the affirmed gender) for the majority who were in later stages of puberty, and puberty-suppressing drugs for the few children still in early puberty.

Spack and colleagues call for further research to assess these adolescents’ psychological well-being after both kinds of treatment. They urge early evaluation for children who show persistent gender-related issues, including consultation with mental health professionals and consideration of medical treatment when patients near puberty.  Anecdotally, children who receive interventions early do better psychologically.

“Just coming to our clinic for an initial visit was associated with a markedly reduced motivation to self-harm,” Spack notes.

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