Kids with gender noncomformity at increased risk for abuse

Boys won't always "act" like boys, and girls won't always "act" like girls. Some boys may choose dolls over tools, and some girls prefer cars, trucks, and football to Barbie dolls and princesses.

Unfortunately, kids who tend to make choices that are not considered typical for their gender are at higher risk of being abused by their parents or other family members, and are at risk for developing post-traumatic stress disorder (PTSD).

This is the main finding of a study that will appear in the March 2012 issue of Pediatrics.

An anxiety disorder that develops after witnessing or surviving a traumatic event, such as physical or sexual abuse, PTSD symptoms may include vivid flashbacks, edginess, and sleeping problems. PTSD has been linked to risky behaviors such as unprotected sex, substance abuse, and physical symptoms such as chronic pain.

"We know that kids who are gender-nonconforming do get bullied more, but this paper looked at abuse by parents or other adults, including sexual abuse," says study author Andrea Roberts. She is a research associate in the department of society, human development, and health at the Harvard School of Public Health in Boston.

Gender Expression

Exactly why these kids are at increased risk for abuse and PTSD is not fully understood.

"Parents may be uncomfortable with their child's gender expression and may think that parenting can change behaviors, so they may become harsher," she says. "Some parents think kids who are non-conforming will grow up to be a gay or lesbian, and if they are not comfortable with this, they may think they can change a kid's future."

"The common perception that they are or will be homosexual is not accurate ... most are not," Roberts tells WebMD.

Her advice is clear: "Accept your children and let go of how you thought things were going to be," she says.

In the study, the researchers polled 9,000 young adults who took part in the Growing Up Today study in 1996. They were asked to recall their childhood experiences. Questions were about favorite toys and games, roles they took while playing, media characters they admired, and whether they felt feminine or masculine.

They also were asked about physical, sexual, or emotional abuse, and were screened for PTSD. The study did not ask kids about how they dressed or wore their hair during childhood.

Men and women who were drawn to toys, TV shows, and characters that were typically associated with the opposite sex were more likely to report sexual, physical, and psychological abuse. Rates of PTSD were almost twice as high among young adults who were gender-nonconforming in childhood when compared with those who were not, the study shows.

Message to the Children: This Too Shall Pass

Things will improve, says Edgardo J. Menvielle, MD. He is a psychiatrist at Children's National Medical Center in Washington, D.C. It may not seem like it, but this too shall pass.

"The teenage years are the worst time for these kids, but we know it gets better," he says. "If kids or teens are in a situation where families are abusive or very critical, they will find other people in the community when they are on their own and grown up. These kids should not feel like they are freaks or abnormal."

Gender roles are changing rapidly in today's world for men and women, with stay-at-home dads, CEO moms, and the emergence of "the manny," says Robin Friedman, a psychotherapist in private practice in Westchester, N.Y., and New York City. "This study points to the fact that in many homes, expressions of gender nonconformity by children and teens are not considered acceptable and may even be looked upon as taboo."

Some parents may respond with love and support, others may respond with concern, or with alarm bells ringing, while others may respond with anger, or emotional or physical abuse, she says.

Victor Fornari, MD, is the director of child/adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y. He says that gender nonconformity is on everyone's radar these days: "People are now more aware of it, but it is not new."

Bullying is an issue for these kids. "Now the data suggests a higher risk for maltreatment than other children," he says. Society is more open about a lot of things today, including homosexuality, and this is a good thing. But "in many families, due to cultural and religious backgrounds, these youth are faced with resistance and anger, and many become depressed and suicidal because of feeling rejected."

Signs of abuse can include feelings of isolation, depression, aggressiveness, decreased self-care, and decreased self-esteem. "Children or teens who are able to recognize these symptoms and feelings in themselves ought to seek help immediately from other caring adults such as teachers, school social workers, or community mental health professionals. There are hotlines available too," Friedman tells WebMD.