Rapid-onset gender dysphoria controversy

Rapid onset gender dysphoria (ROGD) is a hypothesized socially mediated subtype of gender dysphoria. Physician and researcher Lisa Littman created the term to describe the perceived phenomenon, seeking a hypothesis to explain surveyed parents' accounts of their teenage children suddenly manifesting symptoms of gender dysphoria and self-identifying as transgender together with peers in their group of friends, despite parents saying they perceived no previous signs of gender identity uncertainty. Littman further speculated that rapid onset of gender dysphoria could be a "social coping mechanism" for other disorders, such as depression and anxiety caused by adolescent trauma.

Littman published a descriptive study in PLOS One in August 2018. Criticism from transgender activists led to a post-publication review; in March 2019, the journal republished Littman's revised and corrected version, alongside the author's notice stating that she had "updated the Title, Abstract, Introduction, Discussion, and Conclusion sections, to address the concerns raised in the editorial reassessment." Critiques of the study and its validity were published in mainstream media, as were opinion pieces about academic freedom when Brown University removed a press release of the paper.

Publication controversy

Lisa Littman, an American physician and researcher, coined the term "rapid-onset gender dysphoria". Littman's medical specialties are in preventive medicine and public health, as well as obstetrics and gynecology. Her research interests relate to reproductive health, gender dysphoria, detransition, and maternal and child health including prematurity and the use of substances in pregnancy. Littman joined the faculty of the Brown University School of Public Health in 2018 as assistant professor of the practice in Behavioral and Social Sciences.

Littman became interested in the possible role of "social contagion" in gender dysphoria among young people, and conducted a study by surveying around 250 parents recruited from three websites where she had seen parents describe sudden gender transitions in their adolescents. She presented preliminary results at a 2017 conference, and a descriptive study was initially published in PLOS One in August 2018.

Littman's study described cases of a rapid onset of gender dysphoria based on reports by the surveyed parents, along with information that was collected about the children's peer group dynamics, social media use, and prior mental health issues.

According to coverage in the news section of Science, the study found that "among the young people reported on—83% of whom were designated female at birth—more than one-third had friendship groups in which 50% or more of the youths began to identify as transgender in a similar time frame", which the Science coverage described as probably "the most explosive of Littman's findings".

Correction

The paper was met with a strongly negative reaction from transgender activists, who stated reasons such as its already having been politicized, self-selection bias of the subjects that Littman surveyed, and her only surveying the parents, and not the young people themselves nor the health professionals caring for them. PLOS One responded to negative comments by opening a review on the paper, to determine if its conclusions were appropriately stated.

In March 2019, PLOS One completed its post-publication review, and Littman's corrected version of the paper was published on March 19, 2019. In the journal's blog, PLOS One editor Joerg Heber apologized "to the trans and gender variant community" for the previous review and publication, saying that "the study, including its goals, methodology, and conclusions, were not adequately framed in the published version, and that these needed to be corrected." Heber noted that the hypothesized condition of ROGD had "not yet been clinically validated."

In a notice of correction prefacing her updated version of the study, Littman stated:

[T]he post-publication review identified issues that needed to be addressed to ensure the article meets PLOS ONE's publication criteria. Given the nature of the issues in this case, the PLOS ONE Editors decided to republish the article, replacing the original version of record with a revised version in which the author has updated the Title, Abstract, Introduction, Discussion, and Conclusion sections, to address the concerns raised in the editorial reassessment. The Materials and methods section was updated to include new information and more detailed descriptions about recruitment sites and to remove two figures due to copyright restrictions. Other than the addition of a few missing values in Table 13, the Results section is unchanged in the updated version of the article.

PLOS One's editor wrote that "the corrected article now provides a better context of the work, as a report of parental observations, but not a clinically validated phenomenon or a diagnostic guideline".

On behalf of the journal, Heber wrote, "Correcting the scientific record in this manner and in such circumstances is a sign of responsible publishing", where further scrutiny was called for to "clarify whether the conclusions presented are indeed backed up by the analysis and data of that original study." Heber later stated, "At its core, the survey of the parents stands as it is... We let the original results stand."

Status of ROGD

According to Littman, "Rapid-onset gender dysphoria (ROGD) is not a formal mental health diagnosis at this time." She wrote:

This study of parent observations and interpretations serves to develop the hypotheses that rapid-onset gender dysphoria is a phenomenon and that social influences, parent-child conflict, and maladaptive coping mechanisms may be contributing factors for some individuals. ... This report did not collect data from the adolescents and young adults (AYAs) or clinicians and therefore does not validate the phenomenon.

In a formal comment, reviewer Angelo Brandelli Costa wrote, "The level of evidence produced by the Dr. Littman’s study cannot generate a new diagnostic criterion relative to the time of presentation of the demands of medical and social gender affirmation." Costa suggested, "Several procedures still need to be adopted to generate a potential new subcategory of gender dysphoria that has not yet been clinically validated. One of these procedures is the assessment of mental health professionals trained according to the World Professional Association for Transgender Health (WPATH) and the American Psychological Association (APA) guidelines, interviewing not just the family, but the youth (longitudinally)."

A paper critiquing the original study, Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria”, was posted in April, 2019.

Social and political commentary

The 2018 publication of the paper led to controversies that included criticism of the methods used in the study, and disputes concerning academic freedom. On the same day that PLOS One announced its review, Brown University took down a press release they had earlier posted about the paper. The reactions included criticism of Brown by a former dean of Harvard Medical School. A group of 54 academics in the U.K. published an open letter expressing concerns about suppression of academic analysis and discussion of transgenderism "from a range of critical academic perspectives", and stating that some of them had experienced protests, harassment, "foiled plots to bring about dismissal, no-platforming, and attempts to censor academic research and publications."

Responding to critics, Brown University President Christina Paxson and Provost Richard Locke said they had not infringed on academic freedom and stated that Brown's commitment to only "publicize research that unassailably meets the highest standards of excellence" required Brown to retract the press release after PLOS One opened an investigation on the paper in question. They said that "given the concerns raised about research design and methods, the most responsible course of action was to stop publicizing the work published in this particular instance. We would have done this regardless of the topic of the article."

Aside from the questions about the scientific validity of the condition, the political implications of the alleged condition were a source of heated discussion. The hypothesized condition was called "a poisonous lie used to discredit trans people" in the op-ed section of The Guardian, while it was called an explanation for the experiences of multiple parents in the op-ed section of the Wall Street Journal. Publications such as The Conversation and Slate condemned what they saw as politicization of science by social conservatives, while Madeleine Kearns, a contributing writer at National Review, described the alleged condition as "particularly concerning" and called for further study. In Psychology Today, Rutgers University psychology professor Lee Jussim described the PLOS-mandated rewrite of the paper as an "Orwellian correction" where no errors had existed, merely "adding some additional discussion about limitations to the work and some minor reframing", but said the process of peer review had improved the paper.