Archives of Sexual Behavior

, Volume 39, Issue 6, pp 1415–1428 | Cite as

Correlates of Gender Dysphoria in Taiwanese University Students

  • Meng-Chuan Lai
  • Yen-Nan Chiu
  • Kenneth D. Gadow
  • Susan Shur-Fen GauEmail author
  • Hai-Gwo Hwu
Original Paper


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.


Gender dysphoria Gender identity University students Psychopathology Parenting style 



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.


  1. 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.CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. Bodlund, O., Kullgren, G., Sundbom, E., & Hojerback, T. (1993). Personality traits and disorders among transsexuals. Acta Psychiatrica Scandinavica, 88, 322–327.CrossRefPubMedGoogle Scholar
  7. Brown, G. R. (1990). A review of clinical approaches to gender dysphoria. Journal of Clinical Psychiatry, 51, 57–64.PubMedGoogle Scholar
  8. 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
  9. 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.Google Scholar
  10. Coates, S. (1990). Ontogenesis of boyhood gender identity disorder. Journal of the American Academy of Psychoanalysis, 18, 414–438.PubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  13. Cohen-Kettenis, P. T., & Arrindell, W. A. (1990). Perceived parental rearing style, parental divorce and transsexualism: A controlled study. Psychological Medicine, 20, 613–620.CrossRefPubMedGoogle Scholar
  14. Cohen-Kettenis, P. T., & Gooren, L. J. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research, 46, 315–333.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44, 5–14.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. Gadow, K. D., Sprafkin, J., & Weiss, M. (2004). Adult Self-Report Inventory-4 manual. Stony Brook, NY: Checkmate Plus.Google Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. Godlewski, J. (1988). Transsexualism and anatomic sex ratio reversal in Poland. Archives of Sexual Behavior, 17, 547–548.CrossRefPubMedGoogle Scholar
  27. Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press.Google Scholar
  28. Greer, G. (1971). The female eunuch. New York: Bantam Books.Google Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58, 259–261.CrossRefPubMedGoogle Scholar
  32. Hoenig, J., & Kenna, J. C. (1974). The prevalence of transsexualism in England and Wales. British Journal of Psychiatry, 124, 181–190.CrossRefPubMedGoogle Scholar
  33. Huang, S. L., & You, M. H. (Eds.). (2007). Gender dimensions in Taiwanese society. Taipei: Chuliu Publisher.Google Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefPubMedGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. Levine, S. B., & Lothstein, L. (1981). Transsexualism or the gender dysphoria syndromes. Journal of Sex and Marital Therapy, 7, 85–113.PubMedGoogle Scholar
  39. 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.PubMedGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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
  42. Meyer, J. K. (1982). The theory of gender identity disorders. Journal of the American Psychoanalytic Association, 30, 381–418.CrossRefPubMedGoogle Scholar
  43. Meyer, W. J. (2004). Comorbidity of gender identity disorders [Letter]. American Journal of Psychiatry, 161, 934–935.CrossRefPubMedGoogle Scholar
  44. Napholz, L. (1994). Indices of psychological well-being and sex role orientation among working women. Health Care for Women International, 15, 307–316.CrossRefPubMedGoogle Scholar
  45. Parker, G., & Barr, R. (1982). Parental representations of transsexuals. Archives of Sexual Behavior, 11, 221–230.CrossRefPubMedGoogle Scholar
  46. Pauly, I. B. (1968). The current status of the change of sex operation. Journal of Nervous and Mental Disease, 147, 460–471.CrossRefPubMedGoogle Scholar
  47. 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.CrossRefPubMedGoogle Scholar
  48. 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.CrossRefPubMedGoogle Scholar
  49. Savin-Williams, R. C., & Diamond, L. M. (2000). Sexual identity trajectories among sexual-minority youths: Gender comparisons. Archives of Sexual Behavior, 29, 607–627.CrossRefPubMedGoogle Scholar
  50. 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.PubMedGoogle Scholar
  51. Sophie, J. (1985). A critical examination of stage theories of lesbian identity development. Journal of Homosexuality, 12, 39–51.CrossRefPubMedGoogle Scholar
  52. 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.CrossRefPubMedGoogle Scholar
  53. 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.CrossRefPubMedGoogle Scholar
  54. Tsoi, W. F. (1988). The prevalence of transsexualism in Singapore. Acta Psychiatrica Scandinavica, 78, 501–504.CrossRefPubMedGoogle Scholar
  55. 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.CrossRefPubMedGoogle Scholar
  56. Walinder, J. (1971). Incidence and sex ratio of transsexualism in Sweden. British Journal of Psychiatry, 119, 195–196.CrossRefPubMedGoogle Scholar
  57. 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.CrossRefPubMedGoogle Scholar
  58. 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.CrossRefPubMedGoogle Scholar
  59. 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.CrossRefPubMedGoogle Scholar
  60. 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.PubMedGoogle Scholar
  61. World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.Google Scholar
  62. 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
  63. 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.CrossRefPubMedGoogle Scholar
  64. Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.Google Scholar
  65. 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.CrossRefPubMedGoogle Scholar
  66. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Meng-Chuan Lai
    • 1
    • 2
  • Yen-Nan Chiu
    • 1
  • Kenneth D. Gadow
    • 3
  • Susan Shur-Fen Gau
    • 1
    • 4
    Email author
  • Hai-Gwo Hwu
    • 1
    • 4
  1. 1.Department of PsychiatryNational Taiwan University HospitalTaipeiTaiwan
  2. 2.Department of PsychiatryUniversity of CambridgeCambridgeUK
  3. 3.Department of Psychiatry and Behavioral ScienceState University of New YorkStony BrookUSA
  4. 4.Department of Psychiatry, College of MedicineNational Taiwan UniversityTaipeiTaiwan

Personalised recommendations