Adolescent Gender Nonconformity

This post was written by David L. Lopez, M.D., a member of the LGBTQ+ Committee at the Group for the Advancement of Psychiatry.

An increasing number of young people are embracing gender-nonconforming (GNC) identities. A subset of these adolescents may be going through what psychologists call an adolescent identity crisis—a concept introduced by Erik Erikson in 1956. He defined it as a period of uncertainty and exploration that typically occurs during the teenage years concerning one's values, personal beliefs, career choices, roles within the peer group, cultural background, physical attributes, sexual orientation, and gender.

This process is a normal part of development, highlighting the teenage years as a key time for weaving these various aspects of identity into a clear and coherent sense of self.

Importantly, Erikson considered the rebellious nature of adolescents as normal for this stage of life, often exemplified by James Dean in his role as Jim Stark in Rebel Without a Cause, a “tale of tempestuous kids and their weird ways of conducting their social relations.”

Fast-forward to today, when adolescent rebellion is taking on new dimensions as young people experiment with gender in ways that were unthinkable to previous generations. Many of these gender-nonconforming teens are not concerned with medical transitions or surgical modifications; rather, they are writing a brand-new, bold book of self-expression that challenges societal norms.

Definitions

To better understand these issues, the following are some useful definitions adapted from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR):

• Sex: The biological factors that classify someone as male or female, mostly in relation to reproductive capabilities, including sex chromosomes, gonads (ovaries or testes), sex hormones, and physical genitalia.
• Gender: The public and sociocultural roles, behaviors, and attributes that a society considers appropriate for men, women, and other gender identities. This concept includes how individuals are perceived and interact with society as boys, girls, men, women, or other.
• Gender Assignment: This is the initial classification of an individual as male or female at birth, usually based on external physical anatomy, leading to what is commonly known as birth-assigned gender.
• Gender Dysphoria (GD): This refers to the distress experienced due to a discrepancy between a person's experienced gender and the gender assigned at birth or their physical sex characteristics, lasting at least 6 months, as described in the DSM-5-TR. This diagnosis requires the presence of specific criteria related to a strong desire to be of another gender or an insistence that one is another gender. In children, it requires the presence of at least six specific criteria. In adolescents and adults, at least two specific criteria must be met.
• Nonconformity to Gender Roles: Behaviors and interests that do not align with the stereotypical expectations of behavior based on one's assigned gender at birth. This diagnosis includes a wide range of behaviors that might not fit traditional notions of "masculinity" or "femininity."

The Clinical Setting

In clinical practice, it is important for clinicians to distinguish between adolescents exploring gender nonconformity and those who have gender dysphoria (GD). GD, a condition included in the DSM-5-TR, is marked by significant distress with one's assigned gender. Access to medical care may be vital for young people diagnosed with GD due to the potential for emotional despair without treatment.

However, many psychiatrists and mental health experts treat tweens and teens who are exploring gender nonconformity as part of their adolescent journey; they are swapping pronouns and changing their looks without necessarily desiring medical intervention. Their expressions of gender nonconformity may be part of a broader tapestry of self-discovery, better described as nonconformity to gender roles. The DSM-5-TR mentions nonconformity to gender roles as important to differentiate from the diagnosis of GD.

Distinguishing between GD and nonconformity to gender roles associated with an adolescent identity crisis can be challenging. This task is not suitable for laypeople or individuals with limited formal training. Stirring the pot a bit more, to date, there is no extensive population research on either GD or nonconformity to gender roles.

Furthermore, as mental health clinicians support and work with these young explorers, they are becoming increasingly aware that the adolescent identity crisis may not merely be a fleeting phase. Instead, it can represent a profound, personal, and pivotal period in a young person’s journey toward self-acceptance and authenticity.

Yet, it is a well-established principle that the role of mental health workers in clinical practice is not to judge or criticize. Instead, their duty is to meet their patients where they are, acquire adequate training and supervision in this highly specialized area, and stay updated on the latest scientific information regarding these clinical presentations.

Gender Essential Reads

Insights From Research of Teens Unhappy With Their Gender

Hostile and Benevolent Sexism: Two Sides of the Same Coin

So, what might this mean for parents and caregivers of gender-nonconforming teenagers who are going through nonconformity to gender roles as part of their adolescent identity crisis?

First, breathe. Ten years ago, if a tween stated that they wanted to go by a gender-neutral name, it might have been seen as endearing. Now, parents react as if the tween had announced they were joining a traveling circus… tomorrow!

Adults can support tweens and teens by respecting their chosen pronouns and names and by understanding how they express their gender identity without focusing on diagnoses.

Additionally, parents can seek experts who understand these issues and can provide sound advice to both teens and their families.