Is “rapid-onset” gender dysphoria in adolescence a new clinical phenomenon?

Abstract

As in earlier versions of the DSM, the DSM-5-TR has distinct diagnostic criteria sets for gender dysphoria in children vs. adolescents and adults. In birth-assigned males, it has long been known that gender dysphoria in adolescents and adults has an ‘early-onset’ (i.e., childhood) and a ‘late-onset’ (i.e., adolescent/adult) form. Age of onset is reliably associated with several demographic and psychological variables, including sexual orientation, and these factors have implications regarding causal mechanisms that might underlie gender dysphoria. In recent years, it has been argued that a new late-onset form of gender dysphoria, termed ‘rapid-onset,’ distinct from the ‘classical’ late-onset form, has become prominent among adolescents, particularly birth-assigned females. This paper provides a summary of what we know about age-of-onset in contemporary samples of adolescents with gender dysphoria. It concludes with a discussion of the pros and cons of adding age-of-onset subtypes (specifiers) to the diagnostic characterization of gender dysphoria among adolescents and adults in revisions to the DSM-5-TR.