A new study that has drawn criticism from transgender activists finds most teens “come out” as transgender after belonging to a peer group in which multiple friends identify as trans.

Additionally, the study shows most young people announcing they are transgendered have already been identified with at least one mental health disorder.

In the study –  published at PLoS ONE –  that focused on teens who are predominantly female, Lisa Littman, an assistant professor of behavioral and social sciences at Brown University, found 87 percent of the young people were reported by their parents to have “come out” as trans after increased time spent on social media and the Internet and after “cluster outbreaks” of gender dysphoria among their groups of friends. Most of the teens who ultimately identified as transgender also showed increased popularity with peer groups afterward.

Of the teens whose parents participated in the study, 62.5% had been diagnosed with at least one mental health disorder prior to the onset of their gender dysphoria. In 36.8% of the teens’ friendship groups, the majority of the members “came out” as transgendered.

“The most likely outcomes were that AYA [adolescent and young adult children] mental well-being and parent-child relationships became worse since AYAs ‘came out,’” reported Littman, adding:

AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%).

Littman set out to learn more about why the number of adolescent girls identifying as transgender at Britain’s Gender Identity Development Service had increased from 41 percent in 2009 to 69 percent in 2017.

The researcher said she had observed teens without a history of gender dysphoria – a clinical term describing psychological discomfort caused by a sense one’s gender is incompatible with one’s biological sex – were “coming out” as transgender “after a period of immersing themselves in niche websites after similar announcements from friends.”

Littman refers to this phenomenon as “rapid-onset gender dysphoria (ROGD)”:

The onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity.

For her study, Littman recruited 256 anonymous parents of children – who suddenly became gender dysphoric in adolescence – to participate in an online, 90-question survey.

Parental responses showed 87 percent of the teens announced they were transgender after increased time on social media and/or after “cluster outbreaks” of gender dysphoria in their groups of friends. Responses indicated most children who “came out” as transgender became increasingly popular as a result of their announcement.

Additionally, nearly two-thirds of the young people whose parents participated in the survey had already been diagnosed with at least one psychiatric developmental disorder prior to the onset of the gender dysphoria. For example, nearly half of the children had already attempted to harm themselves or had experienced a trauma.

“Peer contagion has been associated with depressive symptoms, disordered eating, aggression, bullying, and drug use,” Littman pointed out as well, and specified a similar situation with eating disorders:

The pro-eating disorder sites provide motivation for extreme weight loss (sometimes calling the motivational content “thinspiration”). Such sites promote validation of eating disorder as an identity, and offer “tips and tricks” for weight loss and for deceiving parents and doctors so that individuals may continue their weight-loss activities. If similar mechanisms are at work in the context of gender dysphoria, this greatly complicates the evaluation and treatment of impacted AYAs.

Littman continued:

The majority (76.5%) of the surveyed parents felt that their child was incorrect in their belief of being transgender. More than a third (33.7%) of the AYAs asked for medical and/or surgical transition at the same time that they announced they were transgender-identified. Two thirds (67.2%) of the AYAs told their parent that they wanted to take cross-sex hormones; 58.7% that they wanted to see a gender therapist/gender clinic; and 53.4% that they wanted surgery for transition. Almost a third (31.2%) of AYAs brought up the issue of suicides in transgender teens as a reason that their parent should agree to treatment. More than half of the AYAs (55.9%) had very high expectations that transitioning would solve their problems in social, academic, occupational or mental health areas. While 43.9% of AYAs were willing to work on basic mental health before seeking gender treatments, a sizable minority (28.1%) were not willing to work on their basic mental health before seeking gender treatment. At least two parents relayed that their child discontinued psychiatric care and medications for pre-existing mental health conditions once they identified as transgender.

Transgender activists have condemned the study, leading Brown University to censor it after it “heard from Brown community members expressing concerns that the conclusions of the study could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.”

Littman posted links to her survey on websites for parents who had reported the rapid onset of gender dysphoria – such as 4thWaveNow, Transgender Trend and youthtranscriticalprofessionals.

As the Economist notes, Diane Ehrensaft, mental health director at a gender clinic in San Francisco, referred to these websites as “anti-trans,” and wrote that “this would be like recruiting from Klan or alt-right sites to demonstrate that blacks really are an inferior race.”

4thWaveNow, a group of “parent-skeptics who question medicalizing gender-atypical youth,” celebrated the study:

In 2012, the American Psychiatric Association (APA) Task Force on the Treatment of Gender Identity Disorder specified that adolescents with gender dysphoria “should be screened carefully to detect the emergence of the desire for sex reassignment in the context of trauma as well as for any disorder (such as schizophrenia, mania, psychotic depression) that may produce gender confusion. When present, such psychopathology must be addressed and taken into account prior to assisting the adolescent’s decision as to whether or not to pursue sex reassignment or actually assisting the adolescent with the gender transition.”

Littman refers to her study as “exploratory,” and says it serves to warn “that clinicians need to be very cautious before relying solely on self-report when AYAs seek social, medical or surgical transition.”