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Please note: This article is written by a psychologist who raises important questions in light of the “transition” narratives linked to gender dysphoria. 

Original Twitter thread by Dr. P (@Psychgirl211)


Psychological distress and aberrant behaviours are always conceptualised through the lens of culture, and in any society, at any given time, we create medical and psychological narratives to best understand aspects of human behaviour based on these prevailing norms. These then go on to shape further behaviours. This is known as the ‘symptom pool’.
Anorexia was almost unknown in Hong Kong until a public awareness campaign was launched by Western psychiatrists in the 1990s. Within a few years there was a 2,500% increase in cases. Girls diagnosed with anorexia were treated sympathetically, they were taken out of school and given positive reinforcement for their illness. Unsurprisingly, more girls began restricting their eating, thus causing a growing feedback loop of youngsters developing anorexia. The awareness campaign in Hong Kong, had in effect, created and spread a novel mental illness (and its behavioural sequalae) into a population of receptive and suggestible adolescents.
In the 1980s and 90s ‘False Memory Syndrome’ led to families being torn apart by accusations of supposed childhood sexual abuse, particularly incest. Through guided imagery, hypnosis and simple suggestion, psychologists encouraged clients (mainly women) to ‘recover’ entirely factitious ‘memories’ of sexual abuse, some supposedly occurring as early as three months old!
After the 2004 Sri Lanka Tsunami, the unknown concept of PTSD was introduced into the general population of Sri Lanka by well-meaning foreign aid agencies.
In the 2000s, Japan saw a surge in the incidence of depression after GlaxoSmithKline released the antidepressant Paxil into the local market.
Even further back, the infamous case of the symptom pool in operation is Salem, Massachusetts, in the late 1600s, where mainly teenage girls (sounds familiar?), fell into the mass delusion that they were being ‘pricked’ (attacked/possessed) by the Devil. Adults ran with this idea. As more girls received positive attention and sympathy by showing symptoms of possession, the contagion spread. The rest, as they say, is history.
Currently the West is in the grip of an unprecedented medical scandal arising from a new entrant to the symptom pool, namely Gender Dysphoria.
Here is why from the perspective of being a nearly 30-year qualified clinical psychologist, I believe that Gender Dysphoria is a false construct. One that has caused, and if not stopped, will continue to cause immeasurable harm to innumerable numbers of people.
The addition of Gender Dysphoria to the symptom pool is fed by the concept of gender identity, an unprovable, metaphysical belief that we all have an innate sense of our ‘gender’. That our gender exists outside of our physical bodies.
Gender Dysphoria occurs when one’s gender identity does not match one’s sexed body.
Following from a diagnosis of Gender Dysphoria is the near inevitability of ‘gender affirming care’. This involves the highly unethical and entirely experimental use of synthetic cross-sex hormones and the surgical mutilation of physically healthy bodies in order to align with one’s supposed gender identity.
But Gender Dysphoria itself is not real. It has no clinical or evidentiary basis. It is a false construct, created ex nihilo and first published in the Diagnostic and Statistical Manual for Mental Disorders (DSM), 5th edition, in October 2013. We psychologists should not be involved in any of it.
A core part of a clinical psychologist’s skill set is psychometric assessment. Psycho/metric literally means ‘measuring the mind’. Psychologists can assess and quantify all manner of psychological properties, qualities and dysfunction occurring in humans. Anxiety, depression, trauma, resilience, suggestibility, marital health, life satisfaction. You name it, we can measure it.
We have hefty catalogues of assessment tools (also known as measures and tests), which can only be purchased according to a qualification code (QL) determined by one’s level of training. The highest level of assessments (such as tests for IQ, and memory) can only be bought by someone holding a QL that corresponds to having a doctoral degree in psychology.
These measures are designed and created by a process of research by academic psychologists. Each test comes with a manual that describes: (1) the process by which it was created; (2) the population on whom it was standardised; (3) contra-indications – whom the test should not be applied to; (4) an explanation of its statistical reliability and validity; and, (5) Case Studies, showing clinical applications of the test. Most measures also have means by which false and/or inconsistent responding can be detected.
Tests will typically have a numerical baseline (below which an individual is deemed asymptomatic, and then a clinical range, usually of mild moderate and severe symptomatology). Each manual has scoring tables. These are usually separated by sex and by age. So, for example, in an autism screener, the norms for a 16-year-old boy will be different than those for an eight-year-old girl, or for an eight-year-old boy. If the wrong set of norms are applied, the result is invalid.
Most tests for children have an: (1) self-report form (completed by the child); (2) a parent form; and (3) a teacher form. Results are collated, compared and computer programmes can assist to do intra and inter-scorer comparisons. Thus, a comprehensive picture of the child’s functioning is obtained.
These measures thus have a firm statistical and empirical basis. They are not dreamed up out of thin air.
A psychologist can use for example, the CISS, (Coping Inventory for Stressful Situations), a scale for measuring coping styles (Task, Emotion, Avoidance-Oriented Coping, distinguishing between males and females), in the USA, in Canada, in France, or Spain and they can know they are each measuring the same thing. Most tests come in different language versions. They determine baseline functioning, and they can be re-administered over time to assess for change following any clinical intervention.
In order to achieve the goals of alleviating distress and improving functioning, Psychologists therefore conduct;
(1) assessments – based on testing, interview and observation;
(2) formulation – identifying the clinical issue, based on the assessment;
(3) intervention – clinical work, directly with the client and/or the client’s family system;
(4) evaluation – measuring the effectiveness of the intervention; and, where necessary,
(5) reformulation – changing one’s intervention, or even evaluation, in to accommodate new information.
None of this happens to obtain the spurious diagnosis of Gender Dysphoria. First, because standardised tests to accurately measure it simply do not exist, and second because the clinical features of Gender Dysphoria are not arrived at by the scientific method: ie formal testing, formulation, intervention, evaluation, and if necessary, reformulation.
Gender Dysphoria is in reality a long con. It is treated as a valid construct only because it appears in the DSM. But the DSM is merely a trade manual for the American Psychiatric Association. It is a revenue-producing commercial publication. In terms of its clinical rigour, the DSM definition of Gender Dysphoria is analogous to a description for an item being sold in the Screwfix Catalogue, or a used car description in Auto Trader Magazine!

Gender Dysphoria was created by committee. Some people sat down in a room in 2013 and simply invented its diagnostic properties. There was no application of the scientific method in its conceptualisation and categorisation. (Genevieve Gluck,

@WomenReadWomen has done a lot of work on this, showing the behind-the-scenes influence of trans activists and castration fetishists in its creation).
This lack of any scientific rigour is reflected in the definition of Gender Dysphoria, which is full of stereotypes and circular reasoning:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
3. A strong desire for the primary and/or secondary sex characteristics of the other gender
4. A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)
I cannot count the number of times I’ve read phrases such as Gender Dysphoria is a real and distressing condition, but …”, being spoken by journalists, commentators and politicians.
Really? I challenge anyone who says this to read the DSM-5 ‘definition’ of Gender Dysphoria!
They will see that it is nonsensical:
  • What is ‘marked’ and what is ‘incongruent’?;
  • What is ‘strong’? How is this measured?;
  • How are ‘desire’ and ‘conviction’ objectively determined?;
  • What are the ‘typical feelings and reactions’ of the ‘other gender? Does this mean girls cry and boys don’t; that girls play with dolls and boys climb trees?;
  • How are these typical feelings determined and quantified?;
  • How can anyone know that what they are feeling belongs to the ‘other gender’?;
  • What is an ‘alternative’ gender?
  • What about differences in culture and upbringing? How are these factored into a ‘diagnosis’ of Gender Dysphoria?
  • Why do these conditions only apply to ‘gender’? Why not race, or wealth, or class, or nationality? Why only this particular social construct?
Also, as an aside, in the IQ test of cognitive capacity, one of the tasks measuring verbal IQ involves defining increasingly complex words, but without using the stimulus word. A demonstrative example is: “what is an elephant?”. This cannot be answered by saying, “an elephant is an elephant”. The correct answer could be: “an elephant is a four-legged mammal from the genus Loxodonta”. But the DSM-5 definition of gender is nothing more than an appallingly facile display of crude, circular reasoning. It essentially says, gender is gender’”. As Humpty Dumpty told Alice, “It means just what I choose it to mean”.
Furthermore, Gender Dysphoria is the ONLY clinical symptom in the DSM-5 whose treatment involves, (or even requires) surgical intervention! Mia Hughes thus rightly describes Gender Dysphoria as “the most dangerous” classification in the DSM-5.
Gender Dysphoria as a diagnosis also lacks what psychologists call ‘face validity’, namely is something measuring (in this case describing), what it appears to be describing? How can a six-year-old with precocious puberty, a 16-year-old autistic boy, a 30-year-old lesbian, and a 50-year-old married autogynephilic (AGP) man who secretly wears his wife’s knickers, who are all at different developmental stages and who have quite dissimilar psycho-social experiences, all be suffering from exactly the same clinical condition? This simply lacks credibility!
Because it has no clinical basis, Gender Dysphoria is, in reality, whatever a client (usually a child) says it is. Children are coached online, often by adult men, into believing they are transgender. This process is, disgustingly, (and revealingly), known as ‘hatching an egg.
Gender Dysphoria is the only psychological construct wherein the client essentially diagnoses themselves and also determines their own severity, (the Humpty Dumpty effect). The therapist is simply expected to ‘affirm’ the client’s false belief. The clinical assessment, intervention, evaluation and reformulation that occurs with every other psychological condition is not allowed. It is often even illegal. In some countries such as Brazil, Taiwan, Ecuador, Argentina, Germany, New Zealand and Canada, a therapist attempting to work ethically, (ie carrying out exploratory psychotherapy such as simply asking a client why they think they are ‘trans’) can lose their practicing license, or even be convicted for practicing so-called ‘conversion therapy’.
And because there is no instrument to measure Gender Dysphoria, there is no way of assessing whether whatever the client is feeling has reached a clinical threshold, its severity, if and when it has reduced or been alleviated, or even if it exists. And yes, clients can lie or be deluded. This is why any assessment for Gender Dysphoria, such as it is, ought to be a systemic and lengthy process to eliminate and redirect individuals who are confabulating. (The UK’s Gender Recognition Act, even though very flawed, may have recognised this by imposing a minimum period of two years). And for children, any assessment of Gender Dysphoria should always involve their family, school and wider social systems. It should never be with the child alone.
To illustrate the parlous, indeed criminal, state of affairs, I was contacted by a mother in California whose 16-year-old non-verbal autistic son was diagnosed with Gender Dysphoria on the strength of a 20-minute text chat with a ‘gender therapist’. A fortnight later he was on Oestrogen, sent to him through the post by the gender clinic. The mother felt it inevitable her son would progress to a penectomy, orchidectomy and eventually vaginoplasty. It appears that when it comes to gender issues, the mental capacity of the client themselves is completely ignored!
Quite simply, anyone can get a ‘diagnosis’ of Gender Dysphoria by just demanding one.
And, as just shown, the lie of Gender Dysphoria is so dangerous because it is the basis upon which the spectacularly ill-named gender-affirming care is based. Once the magical phrase Gender Dysphoria is intoned, clinicians unthinkingly and due to activist pressure, abandon everything they know about the scientific method, child (and adult) safeguarding and all professional ethics and curiosity. They almost instantly initiate the process which sets clients onto a path of irreversible medical harm.
But by ‘diagnosing’ Gender Dysphoria, psychologists are making what are called misattributions. These occur when a person ascribes a behaviour or feeling to the wrong cause; for example, a person experiencing panic may think their physical symptoms (shortness of breath, thudding heart and dizziness) are signs of a heart attack. Similarly, a person with social anxiety thinks everyone is staring and judging them whenever they leave home. Psychologists teach clients how to spot misattributions and how to modify their thinking and thereby behavioural responses. Yet, by agreeing to ‘affirm’ Gender Dysphoria, psychologists are themselves making a huge and catastrophic misattribution and/or are acting out of fear.
We psychologists ought to know better. As a clinical psychologist for nearly 30 years I have encountered only ONE child with gender issues. This was a Palestinian expat boy, who was referred to me when I was working in the Middle East. By contrast, in the UK, over decades of clinical practice I have sat through hundreds of National Health Service team, referral and case study meetings. Not once, ever, was gender raised as a presenting clinical issue for any adult or for any child.
This strongly suggests that Gender Dysphoria is just a new, false and incredibly dangerous explanation for psychological distress arising from developmental, psychosocial and neurobiological conditions that mental health professionals have known about and which we have successfully treated forever. For example conditions and presentations such autism, learning disabilities, bullying, same-sex attraction, family dysfunction, poor peer relationships, emerging mental illness or personality disorder, not liking one’s body, being disturbed by the physical changes of puberty, etc. And also childhood sexual abuse, which, sadly, is a huge driver for later trans identification, especially amongst girls.
But now, shockingly and with supreme irresponsibility, anything and everything that is part of the human condition is being automatically subsumed under the umbrella of Gender Dysphoria.
I am not saying that people who think they have Gender Dysphoria are not feeling something. Their unhappiness and distress is often real. But this is being ascribed to the wrong cause. A calamitous and ruinous misattribution is being made. Namely that there is a mismatch between a person’s presumed gender identity and their supposedly incongruent physical body. Thus, the ‘born in the wrong body’ trope.
I posit instead that Gender Dysphoria belongs in the family of anxiety disorders and should be renamed ‘Body Anxiety Disorder’ (BAD). Psychologists are well able to treat anxiety disorders through talking therapy and behavioural modification. Treatment for BAD would be no different than standard psychotherapy for, say for depression, or anxiety, or relationship problems.
Interestingly, @_CryMiaRiver thinks Autogynephilia should have its own diagnostic category and that Gender Dysphoria, (such as it is), should become a secondary diagnosis to a primary diagnostic category, for example of autism or depression This is an interesting proposition and I look forward to her expanding upon this.
Another clinical psychology colleague, @Jaco_v_Z offers a fascinating psychodynamic explanation for this social contagion, for which the correct intervention is psychotherapy, carried out by a suitably qualified person. This is what psychologists should be doing: using our varying clinical perspectives to offer alternative ways to understand and treat a serious and dangerous belief system that is ravaging Western society. We should be studying, discussing and trying to understand what purports to be Gender Dysphoria. We should not be blindly ‘affirming’ it.
Yet because of fierce ideology and rabid activism, public misunderstanding and cynical manipulation by corporate interests, Gender Dysphoria has managed to carve out a unique place in the therapy realm. A place where standard clinical or psychological rules no longer apply. Nonetheless, despite its infiltration into public consciousness and warping of clinical practice, Gender Dysphoria is a false construct. It is based on nothing more than an incoherent ideology.
The argument is not how this ‘real’ condition should best be treated. Mother Nature is not suddenly making huge numbers of developmental mistakes (to mainly White, Western children). There is no underlying pathology. There should therefore be no hormones, no surgery and no interfering with the course of normally occurring puberty. The only ‘intervention’ to treat BAD should be talk therapy and behavioural modification.
Cultures often get thing wrong and make up factitious explanations to understand distressing events in the world around them. For example, in my parents’ native Guyana, there was a belief in ‘Old Haig’, a disembodied female spirit that attacked and killed new babies. To protect the baby, mothers placed a Bible open at the at the 23rd Psalm under the cot mattress. They also covered all mirrors, as Old Haig was thought enter the house this way. Now, with better medical knowledge and the understanding of sudden infant death syndrome (SIDS), people no longer believe in Old Haig. They instead take evidence-based and effective measures to protect new babies, such as placing them on their backs to sleep with their feet touching the end of the cot and keeping the room temperature low.
A similar conceptual misunderstanding is now happening with the catastrophe that is gender affirming care. Just as did the Guyanese elders of my grandparents’ generation, we too have shown ourselves to susceptible to falling prey to a false belief system. Gender Dysphoria is no more real than the recovered memories of people in the 1980s, or the girls at Salem whose hysteria resulted in 19 executions, including that of Dorothy Goode, who was just four years old.
Although it’s now 400 years after Salem, we, the most sophisticated and educated humans to have ever lived, are yet again making the same mistakes. We are being swept up in a mass hysteria which is leading us to carry out ‘lifesaving healthcare’ on vulnerable children and adults without a shred of empirical evidence.
But this so-called ‘lifesaving healthcare’ is not accidentally iatrogenic (where the harm to the patient caused by the physician’s actions is incidental to their activities). No, gender-affirming care is actively anti-medical. The goal (not by-product) of intervention is the removal of healthy tissue and organs and the disruption of the finely balanced endocrine system. Children and adults who are otherwise in good health are being turned into lifelong medical patients. Their bodies are being destroyed and their IQ and higher cognitive functions are being damaged. They will be subject to progressive disability, chronic pain, intractable infections and endless surgical revisions. They will experience early dementias and probable premature death.
Everyone will bear the cost of this insanity. There will need to be a huge and comprehensive national effort to care for these people as they age, and their bodies and brains begin to break down under the onslaught of these medical interventions.
But for now, money is speaking the loudest. Gender affirming care is the driving force behind a medical market that is growing by 10% annually and which by 2030, will be worth $6.2 billion. And it is fuelled by the false premise of Gender Dysphoria. Our modern equivalent of consorting with the Devil, Old Haig and recovered memories.
Gender Dysphoria is a venal lie that is causing untold damage to innumerable people. Let us reconceptualise Gender Dysphoria for what it truly is: Body Anxiety Disorder (BAD), a novel, culture-bound expression of disordered emotional functioning.
Let clinicians be free to help distressed clients using all of our clinical skills and expertise. Do not tie our hands. Do not criminalise us.
When it comes to Gender Dysphoria, John F Kennedy’s words come to mind. “We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought.”
We must now exercise thought and excise opinions. We must dismantle the teetering, cruel and destructive insanity of gender identity, gender dysphoria and gender-affirming care.
We must drain Gender Dysphoria from our symptom pool.