Gender nonconformity in childhood leads to increased risk of abuse: Study

By Dr. Ananya Mandal, MDFeb 21 2012

According to researchers from Harvard School of Public Health and Children's Hospital Boston, children who do not conform to their gender-expected behaviors and interests are at a higher risk of being abused and facing subsequent traumas. Their work is published in the journal Pediatrics.

Researchers explain that childhood gender nonconformity refers to a phenomenon in which children, before puberty, do not conform to psychological or sociological patterns expected of their gender, or their identification with the opposite gender. Examples include a preference for playmates of the opposite sex, choosing not to take part in activities thought suitable for their gender, and a propensity to cross-dress.

There have been studies that show that childhood gender nonconformity was associated with poorer relationships between the child and parents. However, no studies had looked at whether nonconformity was linked to the risk of abuse or PTSD (posttraumatic stress disorder) during childhood.

Andrea L. Roberts and colleagues set out to determine whether there might be a link between gender nonconformity and childhood sexual, psychological and physical abuse before the age of 11 years. They also examined whether this may be associated with a higher lifetime risk of PTSD.
They gathered data from a self-report questionnaire from the Growing Up Today Study, 2007 wave. The study involved 9,864 respondents, whose average age was 22.7 years. They also tried to determine whether higher childhood abuse exposure might result in a higher rate of PTSD among nonconforming children. They also tried to find out whether childhood gender nonconformity's link to PTSD risk existed regardless of sexual orientation.

The results showed that approximately one in every ten children displays gender nonconformity before reaching 11 years of age. By early adulthood, these children are significantly more likely to have experienced sexual, psychological and physical abuse, as well as PTSD by early adulthood. The most likely abuser was found to be either a parent or some older adult who lived in the household.

Interestingly, however, Roberts also noted that children are likely to display a wide variety of behaviors that have no connection to their future sexual orientation: 85% of gender-non-conforming children in the study were heterosexual in adulthood. Roberts said, “before 11 years of age, children frequently exhibit a wide variety of behaviors that mean nothing about their future sexual preferences.” Roberts added that even children whose nonconformity was mild, faced harmful discrimination and intolerance, with effects that sometimes persisted for the rest of their lives.

Yet boys who displayed gender non-conformity before age 11 were nearly three times as likely to suffer sexual abuse in childhood, compared with gender-typical boys. Non-conforming girls were 60% more likely to be abused sexually than conforming girls. Rates of physical and psychological abuse among non-conforming kids were similar across genders.

Researchers concluded, “We identify gender nonconformity as an indicator of children at increased risk of abuse and probable PTSD. Pediatricians and school health providers should consider abuse screening for this vulnerable population. Further research to understand how gender nonconformity might increase risk of abuse and to develop family interventions to reduce abuse risk is needed.”

The results showed “very clear patterns,” said S. Bryn Austin, one of the study's authors. “The young people who as children were most nonconforming were much more likely to report mistreatment or abuse, within the family, by people outside the family. They were targeted for abuse.” There should be extra precautions taken to protect them, she said. “We are concerned about the health and risk of abuse and harassment targeting children who behave in a way, or express their gender in a way that's not typical,” said Austin, an associate professor of pediatrics at the Children's Hospital Boston and Harvard School of Public Health. “We know there's a lot of bias about how girls and boys are supposed to behave.”

“A lot of children seem to be experimenting with cross-gender behavior, but very few are following through to request gender change as they mature,” wrote Dr. Walter Meyer III, a pediatric psychiatrist at the University of Texas Medical Branch in Galveston, Texas, in a separate commentary published in Pediatrics.