Psychiatric Follow-up of Adolescents with Gender Dysphoria: Marmara University Faculty of Medicine Child Psychiatry Clinic Experience

Objectives:We aimed to investigate the persistence of symptoms, functioning levels and comorbid psychiatric disorders during the psychiatric follow-up of adolescents with gender dysphoria.Materials and Methods:The symptoms associated with gender dysphoria were evaluated based on DSM-5 criteria, whereas the comorbid psychiatric diagnoses were evaluated by kiddie schedule for affective disorders and schizophrenia. The instruments included were a sociodemographic form, child behavior checklist (CBCL), and Children’s Global Assessment scale (CGAS).Results:Twenty female (mean age=13.51±3.96 years) and 33 male (mean age=12.94±3.78 years) adolescents were included. The mean age of the onset of symptoms was 7.42±4.14 years and the mean age of first admission to the psychiatry clinic was 11.35±3.99 years. There were no differences between genders with regard to age of the onset of symptoms and age of first admission. At least one psychopathology was found in 73.6% of the cases, such as attention deficit hyperactivity disorder (47.2%), oppositional defiant disorder (9.4%), conduct disorder (5.7%), generalized anxiety disorder (3.8%), specific phobia (9.4%), social phobia (15.1%), separation anxiety (5.7%), major depression (18.9%). Of the adolescents, 31.3% had total CBCL score, 29.2% had internalizing problem scores and 52.1% had externalizing problem scores above clinical range. 67.3% continued to have symptoms related to gender identity and 37.3% had impaired functioning according to CGAS scores. The mean duration of psychiatric follow-up was 21.58±20.46 months and 46.2% of the adolescents still in the psychiatric follow-up. One fourth of the sample had received medication due to comorbid psychiatric symptoms. In the multiple regression analysis, the increase in CBCL internalizing scores (p=0.004), increase in the level of income (p=0.040) and male gender (p=0.046) were found to decrease the functionality during the follow-up.Conclusion:In individuals with gender dysphoria, having natal male gender and internalizing problems seemed to contribute to the decrease in functioning. Social and cultural features may also have substantial impact. Distress related to being a part of a minority group and having an assigned-experienced gender conflict may lead to psychiatric comorbidities and decrease in functioning