Video 5 – Associated Mental Disorders.

Prof John Whitehall _004

By Professor John Whitehall.

Video 5 – Childhood Gender Dysphoria.

Associated Mental Disorders.

Hello. I’m John Whitehall, a paediatrician, and this is another talk on the subject of Childhood Gender Dysphoria. We have looked at the epidemiology and found that that’s reassuring. The vast majority of children will get over this problem through puberty. We have looked at the introduction to what the treatment is. This is alarming because it is a major intrusion into the mind and the body of the children without any scientific underpinning. We have quoted, not my figures, but we’ve referred to other people’s articles, that there is a scarcity, paucity, hardly any evidence that this involvement may in fact make the child better. We have concluded, in fact, that means that this is experimental.

Now the question is, who were the children in whom we’re going to intrude in such a massive way? What are these children like? Does anyone really know? Well, yes, people do know. People have done studies on it. And what I’m relating now is some of the characteristics of these children.

Now, I don’t want to underestimate for any sense the suffering that the children are undergoing. I don’t want to underestimate the suffering of the parents. Nor do I want to underestimate the goodwill of the doctors involved. What we’re doing is saying, Well, what are these children like who are now announcing confusion or revealing confusion in their gender identity?

Very recently, that is to say halfway through 2018, in one of the major journals of paediatrics care in the world, Paediatrics, put out by the American Academy of Paediatrics, there is a review of the mental disorders, associated mental disorders, in 1333 transgender and gender nonconforming children, diagnosed by a care provider over there, Kaiser Permanente, in their division which deals with California and some nearby states. So, it is not my work. This is Kaiser Permanente work. They had 1333 children that had been diagnosed with Gender Dysphoria. Did they have any other diagnoses? Well, they looked at the children from three to nine, and then nine to seventeen years.

We’ll deal with the little ones first. There were 251 children in that age group from three to nine. 31.7 percent of them had been given diagnoses of mental disorders as well as Gender Dysphoria. Attention deficit disorder, 15 percent. Anxiety, 14 percent. Conduct and disruptive disorders, 2.7 percent. And 5 percent of the trans females were autistic, and 11 percent of the trans males also suffered from depression. That 5 percent is a small figure. Throughout the world other people have found a coincidental rate of even up to 20 percent of these children were autistic. So, that’s a huge figure coming from little children.

What about the bigger children? Those from 10 to 17 years, 73 percent, that’s a huge number, three quarters, had received a medical diagnosis, an associated medical diagnosis of mental disorder. Anxiety, 38 percent. Attention deficit, 19.6 percent. Depressive disorders, 56 percent. Psychosis, 4.7 percent. And schizophrenia spectrum, 1.6 percent. Of these children, 14.5 percent had been so severely affected by associated medical disorder that they had in fact been hospitalised.

Now, being a paediatrician for something like fifty years, I don’t recall ever even being involved with a child who was so mentally disturbed it had to be put into a psychiatric centre. But of these ones, 45 percent, which should worry you that you are selecting, you are in being involved with, a highly vulnerable group of children. 75 percent of them with associated illness. These are troubled children.

The proponents for the medical pathway say, “Well, yeah, they’re troubled, all right. They’re troubled because society doesn’t accept their Gender Dysphoria. And therefore, they are vilified and ostracised and bullied at school. And therefore, we should have special programmes that are anti-bullying at school and explaining what transgender are at school because it’s not that these poor children are mentally ill, most of them and it is caused by society.”

Well, are there any reports that in fact say these diagnoses came first and that Gender Dysphoria came second? Yes, a number of them. I’m talking about one. A review of presentations to a Finnish hospital, from 2011 to 2013, declared 75 percent of those children had been or were currently undergoing child and adolescent psychiatric treatment, for reasons other than Gender Dysphoria, when they sought referral.

Of those, 68 percent had their first contact with psychiatric services due to reasons other than the Gender Dysphoria. In the Finnish study. Depression, 64 percent. Anxiety, 55 percent. Self-harming, psychotic symptoms, conduct disorder, autism spectrum disorder, 26 percent.

It’s a really large percentage of the children who have got the mental disorder of autism with its rigid inability. It’s a mental disorder which has a constrained, confined, definition of what is right and what is wrong, what is real and what is not true. And a number of these children then, one way or another, subsequently becoming confused about what gender they are. That’s really sad and should be treated in a compassionate, caring, helpful way. Not necessarily submitting to hormonal treatment and transgendering operations.

There are established treatments for these medical disorders in children. A comparative, compassionate, sitting down and working out, well, what is going wrong in the family? Where is all this stress coming from? How did the Gender Dysphoria confusion come? Are there medicines that we should be using? Is there counselling that we should be using? This is the standard way that we treat children with mental disorders. We don’t rush to be involved with hormonal treatment or even surgery.

There is a very recent paper which has been controversial because some people don’t like what it says. They have reviewed this new phenomenon of Rapid Onset Gender Dysphoria. Although I have not treated any child with Gender Dysphoria, since I began to write about this two years ago, a lot of parents have communicated with me. Even from Ireland, even from Canada, and certainly probably all states. Most of them are terribly worried about their child. Of course, they would be. And most of those girls are in the early years of puberty who have suddenly declared that they are Gender Dysphoric.

This has all the hallmarks, coming out in clusters of friends, all the hallmarks of other behavioural issues like anorexia nervosa, which we know can come in clusters. Eating disorders are copycat type disorders. That doesn’t minimise the problem. But it raises this concept of a contagious psychological issue.

Okay, so they reviewed in this paper 251 girls with a mean age of 16 years. This is came out just recently. 62.5 percent diagnosed with at least one mental health or neuro-developmental disability. Neuro-developmental disability! They say this is basically autism spectrum disorder, psychosis, borderline personality disorders and so forth.

So, the issue is that we are dealing with a highly vulnerable group. A really suffering group of children who deserve our compassion. And then they were emerging with this added problem that they are confused about their gender. They were confused about everything in life. Life is just so bad I’m so depressed. Or life is so threatening, I’m so anxious. And so forth. All with a psychosis they’ve lost contact with the reality. In the midst of all that confusion, they come up with, “Maybe I’m not a boy after all. Maybe I’m a girl after all.” We have established ways of treating this. We don’t underestimate their suffering involved.

So, there’s a highly vulnerable group of children. What about the parents? Kenneth Zucker, who led that unit in Toronto for a number of years, when he looked at this he said, “I have found that about 50 percent of the mothers of gender identity disorder, this was the older name for it, boys had 2 or more diagnostic interview schedule diagnoses and about 25 percent had three or more diagnoses. A composite measure of maternal psycho-pathology was a very strong correlate of a general measure of the child’s psycho-pathology.” That’s a bit of psychological gobbledygook. That is a bit hard to understand. What is he actually saying? He’s saying that in a very significant percentage of the mother’s involved, they are showing evidence of psychological weakness themselves. This is really sad, and we’re not criticising the mothers. We’re not, not at all. We’re not saying that she’s doing this on purpose. But what we are looking at here is that if there is parental effect on this, and leading to the Gender Dysphoria in the child, we should be looking at analysing and helping the parental distress, not treating the child with hormones. That’s the big issue. We should be looking beyond. We see that the child has got a problem, we should be looking beyond that as to what problems there are in the family and dealing with them in a different way.

He went on to say 53 percent of mothers of dysphoric boys met the diagnosis of borderline personality disorder or depression, compared with 6 percent of others.

Another worker said, “Mothers of dysphoric children had attitudes and practises that encourage symbiosis and discouraged autonomy.” So, in other words the child is clinging too much to the mother.

Where does all this lead? This leads to the issue that we have a group of children, the majority of whom are suffering from, may be suffering from, that is to say maybe the majority, I don’t want to get hung up on the figures here, but we have a large group of very vulnerable children in association with a large group of vulnerable parents.

When we look at are these parents married? Happily married? When I looked at the reports from the Australian Family Court proceedings, most of the children came from broken families. So, there is a huge underpinning here of psychological illness. And that means that we should be approaching this in a standard psychological way, not introducing the children to a medical pathway of hormonal and surgical treatment.

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This video and the other eleven on Childhood Gender Dysphoria and a great deal more information can be found on our website.

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