Understanding the Surge in Gender Dysphoria Cases: A New Perspective on Medical Practice
In a recent exploration of the growing phenomenon of gender dysphoria and its treatment, a new research article published in the Australasian Psychiatry provides context on the increasing number and evolving demographics of patients seeking gender-affirming care. The article offers a novel framework for understanding these changes through the lens of Abnormal Illness Behaviours (AIB) and Abnormal Treatment Behaviours (ATB), concepts originally developed to describe pathological patient and clinician interactions in medical settings.
A Changing Landscape
Over the past decade, there has been a marked increase in the number of individuals, particularly females, presenting with gender dysphoria and seeking gender transition. Historically, the majority of those seeking transition were male, either pre-pubertal or middle-aged. The new trend is largely attributed to adolescents, especially girls, which researchers suggest may be influenced by social contagion—whereby social networks and media may play a role in encouraging these presentations. This shift in demographics raises questions about the underlying causes and the adequacy of current treatment models.
The study delves into the gender-affirming model of care (GAMOC), which has been widely adopted in various countries, including Australia and New Zealand. This model assumes that an individual’s self-reported gender identity, irrespective of their biological sex, should be affirmed without question. It also advocates for a range of interventions, from social affirmation to medical and surgical treatments, often beginning at a very young age.
However, despite the popularity of GAMOC, the authors highlight significant concerns about its effectiveness and safety. They point out that recent reviews, such as those conducted by the National Institute for Health and Care Excellence (NICE) in the UK, have found insufficient evidence supporting the long-term benefits of interventions like puberty blockers and hormone therapy. Additionally, there is growing recognition of the potential risks associated with these treatments, including irreversible physical changes, loss of fertility, and the psychological impact of regret or desistance—where individuals revert to a gender identity consistent with their biological sex after initiating transition.
Introducing a New Analytical Framework
The paper introduces a fresh perspective by applying the concepts of abnormal illness behaviour (AIB) and abnormal treatment behaviour (ATB) to the context of gender dysphoria. AIB, a concept originally described by Pilowsky, refers to maladaptive behaviours by patients who refuse to accept a competent doctor’s formulation of their illness and the recommended treatment. Singh’s extension, ATB, describes a situation where doctors themselves engage in maladaptive behaviours, failing to consider the full context of a patient’s experience or favouring certain treatments based on biases rather than evidence.
Applying these concepts to gender dysphoria, the authors suggest that some patients may be exhibiting AIB by pursuing gender transition as a solution to psychological distress that might have other underlying causes, such as trauma or psychiatric comorbidities. Meanwhile, clinicians may display ATB by uncritically affirming a patient’s self-reported gender identity, potentially neglecting other crucial aspects of their mental health. This type of behaviour has previously been described as “diagnostic overshadowing” and was highlighted as a problem with GAMOC in The Cass Review.
A Case Study Illustration
To illustrate these concepts, the authors present a fictional case study of a patient named Stevie, a 20-year-old transgender woman with a complex psychological background, including trauma, intellectual disability, and social rejection. Stevie’s case is used to demonstrate how a focus on gender affirmation alone, without addressing underlying psychological issues, might represent both AIB and ATB. For Stevie, gender affirmation provides immediate validation and support, yet it may also obscure the deeper causes of his distress, such as past trauma and unresolved mental health issues.
This case exemplifies the potential pitfalls of a purely affirming approach. The study argues that without a more nuanced understanding of the psychological and social factors contributing to gender dysphoria, both patients and clinicians risk engaging in behaviours that could ultimately cause harm.
Challenging the Status Quo
This study offers a significant contribution to current discussions around transgender ideation and its treatment by challenging the prevailing narrative that gender-affirming care is unequivocally beneficial. It calls for a more critical approach to treatment, one that takes into account the full psychological and social context of each patient. By applying the frameworks of AIB and ATB, the authors provide a new lens through which to view the rapid increase in cases, suggesting that both patient and clinician behaviours may be influenced by factors that are not immediately apparent.
In light of these insights, the study calls for a reassessment of current practices in treating gender dysphoria, advocating for more comprehensive mental health evaluations and a cautious approach to medical interventions. This perspective aligns with recent moves by countries like Finland and Sweden, which have begun to prioritize psychological interventions over medical treatments, especially for minors.
A Call for Further Research
Ultimately, the paper underscores the need for further research into the long-term outcomes of gender-affirming interventions and a deeper understanding of the factors driving the increase in gender dysphoria presentations. It suggests that a more careful, individualized approach to treatment—one that considers the possibility of abnormal illness and treatment behaviours—could help mitigate the risks associated with current practices and provide better outcomes for patients.
As this new perspective gains traction, it may well lead to a shift in how gender dysphoria is understood and treated, encouraging a move away from a one-size-fits-all approach toward more tailored, evidence-based care. The insights from this study could have profound implications for the future of gender medicine, highlighting the importance of balancing affirmation with a thorough understanding of each patient’s unique psychological landscape.
- Clarke P, Amos A J, Gender-affirming care through the lens of abnormal illness behaviour and abnormal treatment behaviour. Australasian Psychiatry. 2024. doi:10.1177/10398562241276978
- PILOWSKY, I. (1969), Abnormal illness behaviour. British Journal of Medical Psychology, 42: 347-351. https://doi.org/10.1111/j.2044-8341.1969.tb02089.x
- Singh, B., Nunn, K., Martin, J. and Yates, J. (1981), Abnormal treatment behaviour. British Journal of Medical Psychology, 54: 67-73. https://doi.org/10.1111/j.2044-8341.1981.tb01471.x
- Cass H. The Cass Review – Independent review of gender identity services for children and young people: interim report. [Internet]. [cited 2023 Dec 12]. 2022. https://cass.independent-review.uk/publications/interim-report/
