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Issue With DSM-5 Prevalence Estimate
Hi, so at the start of the "Epidemiology" section it states:
The DSM-5 estimates that about 0.005% to 0.014% of people assigned male at birth (5-14 per 100k) and 0.002% to 0.003% of people assigned female at birth (2-3 per 100k) are diagnosable with gender dysphoria.
And the citation links to page 454 of the DSM-5.
I can't verify since I'm not sure the specific sources used, but my reading of the "Prevalence" section in the DSM is that they are getting these estimates based on face-value number of referrals compared to the general pop. Specifically it says:
Since not all adults seeking hormone treatment and surgical reassignment attend specialty clinics, these rates are likely modest underestimates. Sex differences in rate of referrals to specialty clinics vary by age group.
If these rates are just based on the amount of a population going to specialty clinics, I don't know if it's appropriate at all to use it as an estimate of the % of the population *diagnosable* with gender dysphoria (it'd be an estimate of the % of the population *diagnosed* with GD at one point in time). At the very least it should be qualified, since that's a much stronger statement that could be, e.g., cross referenced with the current amount of people identifying as trans women to say "X% of those identifying as trans women do not have diagnosable gender dysphoria", which wouldn't be a valid conclusion based on my reading of what the DSM is saying. VoeVoeVoe (talk) 23:28, 4 April 2024 (UTC)
- Yes, they are very unrealistic numbers and extremely low. Far too low to be representative of the general population based on available surveys. This study says:
The prevalence of gender dysphoria is difficult to determine in the general population. Previously, the prevalence in adults was thought to range from 0.005% to 0.014% for people assigned male gender at birth and 0.002% to 0.003% for people assigned female gender at birth.18 These estimates are based on referrals to surgical gender reassignment clinics, however, and are therefore likely an underestimate.
Hist9600 (talk) 03:09, 5 April 2024 (UTC) - Yeah, this does seem ripe for rewording. At the very least, @VoeVoeVoe you're correct that it's not accurate to paraphrase the DSM5 prevalence number as an estimate of
people ... diagnosable with gender dysphoria
, and as @Hist9600 points to, there are newer, more confident and likely more accurate prevalence estimations in the literature. Srey Sros 03:20, 5 April 2024 (UTC)- I'm looking at the page in the DSM-5, and even the DSM-5 says that, "not all adults seeking hormone treatment and surgical reassignment attend specialty clinics", and further says that the numbers are likely to be underestimates (p. 454). Yet the numbers were used rather uncritically in the article here. Not a good use of this source. Hist9600 (talk) 15:36, 5 April 2024 (UTC)
- I've updated the article to at least use the DSM-5 source better and include the caveats clearly stated in the DSM-5 itself. Additional criticism of these numbers from other sources may also be appropriate. Hist9600 (talk) 16:29, 5 April 2024 (UTC)
- Nice edit, and agreed. Srey Sros 16:30, 5 April 2024 (UTC)
Bachmann et al.
This source (Bachmann et al. 2024) has been used to support the following claim:
A recent study in Germany found that more than half of young people aged 5-24 across every age subgroup diagnosed with "gender identity disorder" no longer had the diagnosis after five years. Specifically, the persistence rate was 27.3% in 15- to 19-year-old females and 49.7% in 20- to 24-year-old males.
The source is a "Kurzmitteilung" (a short summary as opposed to a full research article) of a study on insurance data from the German Bundesländer, published only a few days ago.
The relevant parts of the source are, from the Ergebnisse section:
In der Längsschnittkohorte (n = 7 885, 47,1 % 20- bis 24-jährig, 37,7 % männlich) wiesen nach fünf Jahren insgesamt nur noch 36,4 % eine gesicherte F64-Diagnose auf, eine Diagnosepersistenz < 50 % zeigte sich in allen Altersgruppen (27,3 % bis 49,7 % ).
and from the Diskussion section:
Die diagnostische Persistenz von unter 50 % in allen Altersgruppen im 5-Jahres-Follow-up entspricht der Literatur und spiegelt vermutlich die Fluidität des Konzepts „Geschlechtsidentität“ im Kindes- und Jugendalter wider (5), kann aber auch als Hinweis auf die Notwendigkeit eines umfassenden, standardisierten diagnostischen Vorgehens interpretiert werden (www.cass.independent-review.uk/publications/final-report).
The authors stress the fact that they have not (for obvious reasons) investigated whether the diagnoses were "valid", and their conclusion is that more work needs to be done to investigate whether the reaults from their initial study hold true, and what the reasons may be for the low persistence of diagnoses. They also conclude that offering various treatment options for gender identity disorder is crucial.
I strongly believe that the source can't be used for the sweeping claim it was used to support, and I am curious why that particular bit of the study was used, and not the bit where the authors show that there is a robust increasing trend in gender dysphoria diagnoses, or the conclusion that it is important to offer a range of gender affirming treatments. But above all, I don't think a primary source consisting of a short summary of research on which insurance codes are used in German health care data is useful as a source. --bonadea contributions talk 09:35, 15 June 2024 (UTC)
- Just FYI, it’s very likely the data in this paper isnt particularly meaningful. It is about diagnostic persistence in the German medical system which requires associated billing events over time. I.e. somebody who is diagnosed with GD but parents don’t let them transition (and as such, there is no ongoing billing events occurring) are counted as desistors in this paper. As are people who delay their transition. Insurance billing events are not a good way of measuring persistence of GD or transgender identity. Zenomonoz (talk) 01:37, 16 June 2024 (UTC)
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