Kelley Winters, Ph.D.
GID Reform Advocates
Jesse Singal, Senior Editor at nymag.com, has enlisted his New York Magazine blog in the promotion of the 80% “desistance” stereotype for gender dysphoric children and youth–the widely publicized presumption that painful distress with birth-assigned sex and gender are just a phase for the great majority of children who suffer it:
While the actual percentages vary from study to study, overall, it appears that about 80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into.
Singal praised the 80% “desistance” presumption as “solid scientific consensus” and boasted that “every” study, not some, but “every study that has been conducted on this has found the same thing.” He scorned those who do not accept the 80% presumption (Tannehill 2016, Serano 2016, Olson and Durwood 2016) as “part of problem,” as essentially “ignoring” science, and preventing “intelligent, informed discussion.”
The real problem, however, is that Singal’s support for the 80% presumption and its promoters from the Toronto Clarke Institute/Centre for Addiction and Mental Health (CAMH) and the Dutch VU University Medical Center rests on a critical, misleading statement in this article:
It’s hard to imagine a kid meeting all the necessary criteria in the DSM-IV and not ‘actually’ being gender dysphoric… Since 63 percent of the subjects in Singh’s study met these criteria, this really wasn’t a sample of children who were ‘just’ gender nonconforming.
The author preceded these remarks with a listing of the 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, APA, 1994)) diagnostic criteria for “Gender Identity Disorder of Children” (GIDC, 302.6) that were used for intake selection in childhood “desistance” studies in Toronto and Amsterdam, but the actual diagnostic criteria contradicted his conclusion. In fact, the DSM-IV Subcommittee on Gender Identity Disorders deliberately chose to allow diagnosis of GIDC without any “explicit wish to be of the opposite sex” (Bradley, et al., 1991)–a loophole that sidestepped gender dysphoria and was corrected in the DSM-5. Subcriterion 1 of Criterion A referenced nonbirth-assigned gender identity but was not required for diagnosis:
“1. Repeatedly stated desire to be, or insistence that he or she is, the other sex.”
Only four of five subcriteria were required to meet Criterion A, and all of the other four subcriteria described gender nonconforming behaviors. Therefore, children could be judged to meet criterion A strictly on the basis of gender nonconformity, with no indication of actual gender dysphoria or incongruent gender identity.
Criterion B referenced gender dysphoria (in the Fisk, 1973, sense of distress with physical sex characteristics or assigned gender roles) but once again had loopholes that allowed diagnosis because of behavioral gender nonconformity without evidence of actual gender dysphoria. Birth-assigned boys could meet criterion B with “aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities.” So could birth-assigned girls with a “marked aversion toward normative female clothing.”
Criterion C excluded diagnosis for children with intersex conditions.
Criterion D was the clinical significance criterion, added to almost all categories in the DSM-IV. It required significant distress or impairment in “social, occupational, or other important areas of functioning.” However, the GIDC supporting text in the DSM-IV Text Revision (DSM-IV-TR, APA 2000, p. 577) maintained that distress from societal prejudice, rather than from gender dysphoria itself, would meet criterion D according to its authors.
Gender nonconforming children with no actual evidence of gender dysphoria were very easily misdiagnosed with “Gender Identity Disorder of Children” because of flawed diagnostic criteria the DSM-IV. Those criteria, and, astonishingly, subthreshold fulfillment of them, were used for sample selection in questionable studies that to this day are cited to support the 80% “desistance” myth (Winters 2008, 2014).
Conflation of a much larger superset of gender nonconforming children with a much smaller subset of gender dysphoric kids is not “solid scientific consensus.” Gender nonconformity is not gender dysphoria. Children who were never gender dysphoric to begin with are not “desistant.”
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.
S. Bradley, Ray Blanchard, et al. (1991). Interim Report of the DSM-IV Subcommittee on Gender Identity Disorder. Archives of Sexual Behavior, Vol. 20, 4, p. 339.
Fisk, N. (1973). Gender dysphoria syndrome. (The how, what, and why of a disease). In D. Laub & P. Gandy (Eds.), Proceedings of the second interdisciplinary symposium on gender dysphoria syndrome (pp. 7–14). Palo Alto, CA: Stanford University Press.
Olson, K. and Durwood, L. (2016) Are Parents Rushing to Turn Their Boys Into Girls? Slate, Jan. 14. http://www.slate.com/blogs/outward/2016/01/14/what_alarmist_articles_about_transgender_children_get_wrong.html
Serano, J. (2016) placing Ken Zucker’s clinic in historical context. Whipping Girl, Feb. 9. http://juliaserano.blogspot.com/2016/02/placing-ken-zuckers-clinic-in.html
Singal, J. (2016). What’s Missing From the Conversation About Transgender Kids, Science of Us, New York Magazine, July 25. http://nymag.com/scienceofus/2016/07/whats-missing-from-the-conversation-about-transgender-kids.html
Tannehill, B. (2016). The End of the Desistance Myth. Huffington Post: the Blog, Jul 18. http://www.huffingtonpost.com/brynn-tannehill/the-end-of-the-desistance_b_8903690.html
Winters, K. (2008). Disallowed Identities, Disaffirmed Childhood. GID Reform Blog: Issues on reform of the diagnostic categories of Gender Identity Disorder and Transvestic Fetishism in the DSM-5, Oct. 28. https://gidreform.wordpress.com/2008/10/28/disordered-identities-disaffirmed-childhood/
Winters, K. (2014). Methodological Questions in Childhood Gender Identity ‘Desistence’ Research. 23rd World Professional Association for Transgender Health Biennial Symposium, Feb. 16, 2014, Bangkok, Thailand. https://gidreform.wordpress.com/2014/02/25/methodological-questions-in-childhood-gender-identity-desistence-research/
Zucker, K. and Bradley, S. (1995). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents, Guilford Press, p58