BPSU - Gender Identity Disorder

Surveillance of gender identity disorder concluded in May 2013. This study was a dual surveillance project collecting data both through the BPSU and the Child and Adolescent Psychiatric Surveillance System (CAPSS) at the Royal College of Psychiatrists. 

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Sophie - photo.JPG

Lead investigator 

Dr Sophie Khadr, Academic Clinical Lecturer
UCL Institute of Child Health
30 Guilford Street
London WC1N 1EH

Tel: 0207 905 2190
Email: s.khadr@ich.ucl.ac.uk


  • This UK and Republic of Ireland study aims to determine the incidence of Gender Identity Disorder (GID) among children and young people aged 4-15.9 years. GID occurs when a person’s gender identity differs from their biological sex, causing distress (gender dysphoria). 
  • This is a joint study between the British Paediatric Surveillance Unit and the Child and Adolescent Psychiatry Surveillance System.
  • Clinicians reporting a case that meets the case definition criteria will be sent a brief questionnaire to establish basic clinical details about the child or young person concerned.  A follow-up questionnaire will be sent at one and two years post-notification. 
  • This study will provide important population-level data about the incidence, clinical presentation, co-morbidities and stability/persistence of gender dysphoria at one and two years. 
  • This data will inform service provision for and clinical management of this vulnerable group of patients.              

Case definition: BOTH the following criteria (1 and 2) should be fulfilled:

1. A strong cross-gender identification for ≥ 6 months
(i) In children <12 years, this requires 2 or more of the following:
a) In boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing;
b) Strong preferences for cross-sex roles in make-believe play or fantasies of being the other sex;
c) Intense desire to participate in stereotypical games/pastimes of the other sex;
d) Strong preference for playmates of the other sex.
(ii) In adolescents ≥ 12 years, this requires 1 or more of the following:
a) Frequent passing as the other sex (adopts clothing, hairstyle of the other sex)
b) Desire to live and be treated as the other sex
c) Belief that their feelings and reactions are typical of the other sex
2. a) Distress or unhappiness with his/her biological sex
(e.g. Stated dislike of/aversion to or self-inflicted injury to their primary or secondary
sexual characteristics, request for physical intervention to alter their physical sexual
characteristics to those of the other sex)
b) Stated desire to be or belief that he/she is or should be the other sex
(i) GID cannot be diagnosed in children with known intersex conditions (disorders of sexual differentiation)
(ii) Major psychotic disorder in which gender is one element of a wider delusional system. Cases where gender identity is the only identified “delusion” should be included.
Reporting instructions: Please report any child/young person aged 4-15 years inclusive (i.e. 4-15.9 years) meeting the case definition criteria below for the first time in the last month. If the clinician is uncertain or awaiting confirmation, the child should still be reported.

Duration: November 2011 – November 2012 (13 months of surveillance). Follow-up until December 2014.

Funding: Tavistock & Portman grant via the Advisory Group for National Specialised Services                                 

Ethical approval: This study has been approved by London Bloomsbury REC (REC Ref: 11/LO/1512)  and the National Information Governance Board (NIGB) under Section 251.  (Ref: ECC 8-02(FT4)/2011)                               

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