Skip to main content

Advertisement

SpringerLink
Log in

Correlates of Gender Dysphoria in Taiwanese University Students

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

There have been no published reports regarding the epidemiological and psychiatric features of gender dysphoria in non-clinical young adults. The current study aimed to investigate the demographics, co-occurring psychiatric symptoms, and perceived parenting style and family support in Taiwanese young adults with gender dysphoria. The sample consisted of 5010 university freshmen (male, 51.6%) with a mean age of 19.6 years (SD = 2.7) from a national university in Taiwan. The questionnaires used for this university-based survey included the Adult Self Report Inventory-4 for psychopathology (including gender dysphoria), the Parental Bonding Instrument for parenting style, and the Family APGAR for perceived family support. Results showed that gender dysphoria was more prevalent in females (7.3%) than males (1.9%). Young adults with gender dysphoria were more likely to meet a wide but specific range of co-occurring psychiatric symptoms. The most significantly associated symptoms for males were agoraphobia, hypochondriasis, manic episode, and pathological gambling, and for females dissociative disorder, hypochondriasis, and body dysmorphic disorder. Both males and females with gender dysphoria perceived significantly less support from their families and less affection/care from both parents. Findings suggest that gender dysphoria, associated with a specific range of psychopathology and family/parenting dissatisfaction (with both similar and dissimilar patterns between sexes), is not uncommon in Taiwanese university students, particularly in females. This implies the importance of attention and specific measures to offset psychiatric conditions and to promote mental well-being of this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • a Campo, J., Nijman, H., Merckelbach, H., & Evers, C. (2003). Psychiatric comorbidity of gender identity disorders: A survey among Dutch psychiatrists. American Journal of Psychiatry, 160, 1332–1336.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

  • Bailey, J. M., Dunne, M. P., & Martin, N. G. (2000). Genetic and environmental influences on sexual orientation and its correlates in an Australian twin sample. Journal of Personality and Social Psychology, 78, 524–536.

    Article  PubMed  Google Scholar 

  • Bakker, A., van Kesteren, P. J., Gooren, L. J., & Bezemer, P. D. (1993). The prevalence of transsexualism in The Netherlands. Acta Psychiatrica Scandinavica, 87, 237–238.

    Article  PubMed  Google Scholar 

  • Bodlund, O., Kullgren, G., Sundbom, E., & Hojerback, T. (1993). Personality traits and disorders among transsexuals. Acta Psychiatrica Scandinavica, 88, 322–327.

    Article  PubMed  Google Scholar 

  • Brown, G. R. (1990). A review of clinical approaches to gender dysphoria. Journal of Clinical Psychiatry, 51, 57–64.

    PubMed  Google Scholar 

  • Chang, S. S., Hwu, H. G., & Yen, Y. K. (2006). The community epidemiology of psychosexual dysfunctions and transsexualism. Medicine Today Monthly, 33, 993–1005.

    Google Scholar 

  • Chien, Y. L., Gau, S. S., & Gadow, K. D. (2009). Gender difference in psychiatric syndromes and psychiatric concurrent patterns in Taiwanese college students. Manuscript submitted for publication.

  • Coates, S. (1990). Ontogenesis of boyhood gender identity disorder. Journal of the American Academy of Psychoanalysis, 18, 414–438.

    PubMed  Google Scholar 

  • Coates, S., & Person, E. S. (1985). Extreme boyhood femininity: Isolated behavior or pervasive disorder? Journal of the American Academy of Child Psychiatry, 24, 702–709.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Cohen-Kettenis, P. T., & Arrindell, W. A. (1990). Perceived parental rearing style, parental divorce and transsexualism: A controlled study. Psychological Medicine, 20, 613–620.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., & Gooren, L. J. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research, 46, 315–333.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., Owen, A., Kaijser, V. G., Bradley, S. J., & Zucker, K. J. (2003). Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology, 31, 41–53.

    Article  PubMed  Google Scholar 

  • Cole, C. M., O’Boyle, M., Emory, L. E., & Meyer, W. J. (1997). Comorbidity of gender dysphoria and other major psychiatric diagnoses. Archives of Sexual Behavior, 26, 13–26.

    Article  PubMed  Google Scholar 

  • Cook, R. (1993). The relationship between sex role and emotional functioning in patients undergoing assisted conception. Journal of Psychosomatic Obstetrics and Gynaecology, 14, 31–40.

    Article  PubMed  Google Scholar 

  • Coolidge, F. L., Thede, L. L., & Young, S. E. (2002). The heritability of gender identity disorder in a child and adolescent twin sample. Behavior Genetics, 32, 251–257.

    Article  PubMed  Google Scholar 

  • Cox, B. J., Enns, M. W., & Clara, I. P. (2000). The Parental Bonding Instrument: Confirmatory evidence for a three-factor model in a psychiatric clinical sample and in the National Comorbidity Survey. Social Psychiatry and Psychiatric Epidemiology, 35, 353–357.

    Article  PubMed  Google Scholar 

  • De Cuypere, G., Van Hemelrijck, M., Michel, A., Carael, B., Heylens, G., Rubens, R., et al. (2007). Prevalence and demography of transsexualism in Belgium. European Psychiatry, 22, 137–141.

    Article  PubMed  Google Scholar 

  • Deogracias, J. J., Johnson, L. L., Meyer-Bahlburg, H. F., Kessler, S. J., Schober, J. M., & Zucker, K. J. (2007). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Journal of Sex Research, 44, 370–379.

    PubMed  Google Scholar 

  • Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44, 5–14.

    Article  PubMed  Google Scholar 

  • Drummond, K. D., Bradley, S. J., Peterson-Badali, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., Sprafkin, J., & Weiss, M. (2004). Adult Self-Report Inventory-4 manual. Stony Brook, NY: Checkmate Plus.

    Google Scholar 

  • Gau, S. S., Shen, H. Y., Chou, M. C., Tang, C. S., Chiu, Y. N., & Gau, C. S. (2006). Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. Journal of Child and Adolescent Psychopharmacology, 16, 286–297.

    Article  PubMed  Google Scholar 

  • Godlewski, J. (1988). Transsexualism and anatomic sex ratio reversal in Poland. Archives of Sexual Behavior, 17, 547–548.

    Article  PubMed  Google Scholar 

  • Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press.

    Google Scholar 

  • Greer, G. (1971). The female eunuch. New York: Bantam Books.

    Google Scholar 

  • Haraldsen, I. R., & Dahl, A. A. (2000). Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults. Acta Psychiatrica Scandinavica, 102, 276–281.

    Article  PubMed  Google Scholar 

  • Heider, D., Matschinger, H., Bernert, S., Vilagut, G., Martinez-Alonso, M., Dietrich, S., et al. (2005). Empirical evidence for an invariant three-factor structure of the Parental Bonding Instrument in six European countries. Psychiatry Research, 135, 237–247.

    Article  PubMed  Google Scholar 

  • Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58, 259–261.

    Article  PubMed  Google Scholar 

  • Hoenig, J., & Kenna, J. C. (1974). The prevalence of transsexualism in England and Wales. British Journal of Psychiatry, 124, 181–190.

    Article  PubMed  Google Scholar 

  • Huang, S. L., & You, M. H. (Eds.). (2007). Gender dimensions in Taiwanese society. Taipei: Chuliu Publisher.

    Google Scholar 

  • Hwu, H. G., Yeh, E. K., & Chang, L. Y. (1989). Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatrica Scandinavica, 79, 136–147.

    Article  PubMed  Google Scholar 

  • Iervolino, A. C., Hines, M., Golombok, S. E., Rust, J., & Plomin, R. (2005). Genetic and environmental influences on sex-typed behavior during the preschool years. Child Development, 76, 826–840.

    Article  PubMed  Google Scholar 

  • Kersting, A., Reutemann, M., Gast, U., Ohrmann, P., Suslow, T., Michael, N., et al. (2003). Dissociative disorders and traumatic childhood experiences in transsexuals. Journal of Nervous and Mental Disease, 191, 182–189.

    Article  PubMed  Google Scholar 

  • Knafo, A., Iervolino, A. C., & Plomin, R. (2005). Masculine girls and feminine boys: Genetic and environmental contributions to atypical gender development in early childhood. Journal of Personality and Social Psychology, 88, 400–412.

    Article  PubMed  Google Scholar 

  • Levine, S. B., & Lothstein, L. (1981). Transsexualism or the gender dysphoria syndromes. Journal of Sex and Marital Therapy, 7, 85–113.

    PubMed  Google Scholar 

  • Liao, S. C., Lee, M. B., Lee, Y. J., Weng, T., Shih, F. Y., & Ma, M. H. (2002). Association of psychological distress with psychological factors in rescue workers within two months after a major earthquake. Journal of the Formosan Medical Association, 101, 169–176.

    PubMed  Google Scholar 

  • Lizardi, H., & Klein, D. N. (2002). Evidence of increased sensitivity using a three-factor version of the Parental Bonding Instrument. Journal of Nervous and Mental Disease, 190, 619–623.

    Article  PubMed  Google Scholar 

  • Lothstein, L. M. (2006). The scientific foundations of gender identity disorder. In T. G. Plante (Ed.), Mental disorders of the new millennium (Vol. 2, pp. 227–250). Westport, CT: Praeger Publishers.

    Google Scholar 

  • Meyer, J. K. (1982). The theory of gender identity disorders. Journal of the American Psychoanalytic Association, 30, 381–418.

    Article  PubMed  Google Scholar 

  • Meyer, W. J. (2004). Comorbidity of gender identity disorders [Letter]. American Journal of Psychiatry, 161, 934–935.

    Article  PubMed  Google Scholar 

  • Napholz, L. (1994). Indices of psychological well-being and sex role orientation among working women. Health Care for Women International, 15, 307–316.

    Article  PubMed  Google Scholar 

  • Parker, G., & Barr, R. (1982). Parental representations of transsexuals. Archives of Sexual Behavior, 11, 221–230.

    Article  PubMed  Google Scholar 

  • Pauly, I. B. (1968). The current status of the change of sex operation. Journal of Nervous and Mental Disease, 147, 460–471.

    Article  PubMed  Google Scholar 

  • Ross, M. W., Walinder, J., Lundstrom, B., & Thuwe, I. (1981). Cross-cultural approaches to transsexualism: A comparison between Sweden and Australia. Acta Psychiatrica Scandinavica, 63, 75–82.

    Article  PubMed  Google Scholar 

  • Sato, T., Narita, T., Hirano, S., Kusunoki, K., Sakado, K., & Uehara, T. (1999). Confirmatory factor analysis of the Parental Bonding Instrument in a Japanese population. Psychological Medicine, 29, 127–133.

    Article  PubMed  Google Scholar 

  • Savin-Williams, R. C., & Diamond, L. M. (2000). Sexual identity trajectories among sexual-minority youths: Gender comparisons. Archives of Sexual Behavior, 29, 607–627.

    Article  PubMed  Google Scholar 

  • Smilkstein, G. (1978). The family APGAR: A proposal for a family function test and its use by physicians. Journal of Family Practice, 6, 1231–1239.

    PubMed  Google Scholar 

  • Sophie, J. (1985). A critical examination of stage theories of lesbian identity development. Journal of Homosexuality, 12, 39–51.

    Article  PubMed  Google Scholar 

  • Sprafkin, J., Gadow, K. D., Weiss, M. D., Schneider, J., & Nolan, E. E. (2007). Psychiatric comorbidity in ADHD symptom subtypes in clinic and community adults. Journal of Attention Disorders, 11, 114–124.

    Article  PubMed  Google Scholar 

  • Sreenivasan, U. (1985). Effeminate boys in a child psychiatric clinic: Prevalence and associated factors. Journal of the American Academy of Child Psychiatry, 24, 689–694.

    Article  PubMed  Google Scholar 

  • Tsoi, W. F. (1988). The prevalence of transsexualism in Singapore. Acta Psychiatrica Scandinavica, 78, 501–504.

    Article  PubMed  Google Scholar 

  • van Beijsterveldt, C. E., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35, 647–658.

    Article  PubMed  Google Scholar 

  • Walinder, J. (1971). Incidence and sex ratio of transsexualism in Sweden. British Journal of Psychiatry, 119, 195–196.

    Article  PubMed  Google Scholar 

  • Wallien, M. S., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423.

    Article  PubMed  Google Scholar 

  • Wallien, M. S., Swaab, H., & Cohen-Kettenis, P. T. (2007). Psychiatric comorbidity among children with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1307–1314.

    Article  PubMed  Google Scholar 

  • Weitze, C., & Osburg, S. (1996). Transsexualism in Germany: Empirical data on epidemiology and application of the German Transsexuals’ Act during its first ten years. Archives of Sexual Behavior, 25, 409–425.

    Article  PubMed  Google Scholar 

  • Wilson, P., Sharp, C., & Carr, S. (1999). The prevalence of gender dysphoria in Scotland: A primary care study. British Journal of General Practice, 49, 991–992.

    PubMed  Google Scholar 

  • World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.

    Google Scholar 

  • Zucker, K. J. (2007). Gender identity disorder. In A. Martin & F. R. Volkmar (Eds.), Lewis’ child and adolescent psychiatry: A comprehensive textbook (4th ed., pp. 669–680). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  • Zucker, K. J. (2008). On the “natural history” of gender identity disorder in children [Editorial]. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1361–1363.

    Article  PubMed  Google Scholar 

  • Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Zucker, K. J., Bradley, S. J., & Lowry Sullivan, C. B. (1996). Traits of separation anxiety in boys with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 791–798.

    Article  PubMed  Google Scholar 

  • Zucker, K. J., Bradley, S. J., & Sanikhani, M. (1997). Sex differences in referral rates of children with gender identity disorder: Some hypotheses. Journal of Abnormal Child Psychology, 25, 217–227.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from National Taiwan University Hospital (NTUH-92-S07) and from the Office of Student Affairs, National Taiwan University. The preparation of this manuscript was supported by National Health Research Institute (NHRI-EX96-9407PC), Taiwan. The authors would like to thank the reviewers and the Editor for their insightful suggestions on the revision of the manuscript. Dr. Gadow is a shareholder in Checkmate Plus, publisher of the ASRI-4.

Author information

Authors and Affiliations

  1. Department of Psychiatry, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 10002, Taipei, Taiwan

    Meng-Chuan Lai, Yen-Nan Chiu, Susan Shur-Fen Gau & Hai-Gwo Hwu

  2. Department of Psychiatry, University of Cambridge, Cambridge, UK

    Meng-Chuan Lai

  3. Department of Psychiatry and Behavioral Science, State University of New York, Stony Brook, NY, USA

    Kenneth D. Gadow

  4. Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan

    Susan Shur-Fen Gau & Hai-Gwo Hwu

Authors
  1. Meng-Chuan Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yen-Nan Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth D. Gadow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Shur-Fen Gau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hai-Gwo Hwu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan Shur-Fen Gau.

Appendix: Symptom Clusters Examined by the ASRI-4

Appendix: Symptom Clusters Examined by the ASRI-4

Anxiety disorders: generalized anxiety disorder, specific phobia, social phobia, agoraphobia, and panic disorder

Obsessive–compulsive disorder

Tic disorders: motor and vocal tics

Somatoform disorders: somatization disorder, hypochondriasis, and body dysmorphic disorder

Stress-response disorders: post-traumatic stress disorder and adjustment disorder

Mood disorders: major depressive episode, dysthymic disorder, and manic episode

Sleep disorders: insomnia, hypersomnia, narcolepsy, and nightmare disorder

Eating disorders: anorexia nervosa and bulimia nervosa

Disruptive behavior disorders: attention deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder

Impulse-control disorders: intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania

Dissociative disorder

Gender identity disorder

Substance use

Schizophrenia

Personality disorders: schizoid personality disorder, antisocial personality disorder, and borderline personality disorder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lai, MC., Chiu, YN., Gadow, K.D. et al. Correlates of Gender Dysphoria in Taiwanese University Students. Arch Sex Behav 39, 1415–1428 (2010). https://doi.org/10.1007/s10508-009-9570-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-009-9570-y

Keywords

Search

Navigation