|
 
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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 8
| Issue : 2 | Page : 125-134 |
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The adaptation of gender identity / gender dysphoria questionnaire for adults: Turkish validity and reliability studies
Nevzat Tarhan1, Emel Sari Gokten2, Aylin Tutgun-Unal3, Ayse Sahin4
1 Department of Psychiatry, Uskudar University, NPIstanbul Neuropsychiatry Hospital, Istanbul, Turkey
2 Department of Child and Adult Psychiatry, NPIstanbul Neuropsychiatry Hospital, Istanbul, Turkey
3 Department of New Media and Journalism, Faculty of Communication, Uskudar University, Istanbul, Turkey
4 Clinical Psychologist, Department of Child and Adult Psychiatry, NPIstanbul Neuropsychiatry Hospital, Istanbul, Turkey
| Date of Submission | 12-May-2021 |
| Date of Acceptance | 01-Jul-2021 |
| Date of Web Publication | 13-Aug-2021 |
Correspondence Address:
Aylin Tutgun-Unal
Department of New Media and Journalism, Faculty of Communication, Uskudar University, Istanbul
Turkey
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jnbs.jnbs_23_21
Background: The fact that the concepts of sexual identity and gender dysphoria have become more important all over the world and in Turkey has led clinicians to need powerful measuring tools to evaluate and comment on this structure. Aims and Objectives: The aim of this study is to investigate language equivalence, validity, and reliability studies of the Turkish version of the Gender Identity / Gender Dysphoria Questionnaire for Adult (GIDQ), which was developed by Deogracias et al. (2007). Materials and Methods: The scale was applied to 368 individuals (heterosexual and nonheterosexual) consisting of university students and trans-oriented individuals. Pearson's correlation coefficients revealed positive and significant values in the consistency analysis between the English and Turkish forms for linguistic equivalence studies of the GIDQ Adult Form for ages 18 and over. Results: The factor analysis performed to determine the construct validity of the 5-item Likert type scale, the original of which has a single factor and 27 items, a single factor, and 25-item structure were obtained which accounted for 51.8% of the total variance. When the internal consistency of the scale was calculated, the Cronbach Alpha value was found to be 0.89. Conclusion: According to the comparison of three groups (heterosexual, nonheterosexual, and those with gender dysphoria), average calculations, and effect size (d) analyses in the discrimination validity studies, it was observed that the gender dissatisfaction of university students was at a low level. It was found to be close to the intermediate level in the nonheterosexual male group. The results show that the Turkish form of the scale is valid and reliable.
Keywords: Gender dysphoria, heterosexuality, scale, sexual identity, transsexuality
How to cite this article:
Tarhan N, Gokten ES, Tutgun-Unal A, Sahin A. The adaptation of gender identity / gender dysphoria questionnaire for adults: Turkish validity and reliability studies. J Neurobehav Sci 2021;8:125-34 |
How to cite this URL:
Tarhan N, Gokten ES, Tutgun-Unal A, Sahin A. The adaptation of gender identity / gender dysphoria questionnaire for adults: Turkish validity and reliability studies. J Neurobehav Sci [serial online] 2021 [cited 2023 Mar 24];8:125-34. Available from: http://www.jnbsjournal.com/text.asp?2021/8/2/125/323808 |
| Introduction | |  |
Gender dysphoria is a phenomenon that is visible in different cultures and history with a long history. It is a problematic that must be handled carefully due to its spiritual, social, and legal consequences, and that the treatment process should be well managed with multidisciplinary teamwork. The increasing number of people applying for the trans conversion process over the years suggests that physicians working in both psychiatric clinics and other fields of medicine will encounter transgender people more frequently in the coming years.[1]
Biological gender is the concept of sex-linked to chromosomes, sexual hormones, internal and external sex organs, reproductive cells, the basis of which is based on the process of fertilization and birth. Psychologically and socially, the perception and acceptance of a person to be a man or a woman, their sexual orientation and sexual behavior in line with this perception and acceptance are the determinants of sexual identity. Biological, genetic, familial, social, and cultural factors are thought to play a role in the development of sexual identity. However, our knowledge of the complex interaction of all these etiological factors is limited.[2]
Gender dysphoria is a concept that indicates a mismatch between one's biological sex and gender identity, dissatisfaction with one's body, a strong desire to have the body characteristics of the opposite sex, and a desire to be treated as the opposite sex.[1] This disorder, which begins from childhood, can accompany other psychopathologies, as well as be limited to a level that does not restrict a person's life in many areas.[3]
Retrospective studies of transgender adult patients in the 1960s indicated that their dissatisfaction with their gender began in early childhood, and found that they showed opposite sex behaviors in childhood. Therefore, the thought has occurred that children with gender dysphoria in childhood would be transgender in their adulthood.[4] In the first systematic study on this issue, 44 children with gender dysphoria and 34 children who were not, have been reassessed for the first time at an average age of 7, then at an average age of 19. They reported that 75% of these children had transgender, homosexual, and bisexual behaviors during adolescence or young adulthood, and 80% had fantasy levels of transgender, homosexual and bisexual tendencies. Only one child (2.2%) had continued gender dysphoria. There was no significant difference between those treated and those who were not treated within the group.[5] In a study conducted by Drummond et al., 25 girls with gender dysphoria were first evaluated when they were 9 years old on average and were monitored until the average age of 23. Only 3 (12%) of these 25 girls continued to experience gender dysphoria. At the level of behavior and fantasy, 24%–32% were found to be bisexual or homosexual, and 44%–60% were found to have heterosexual sexual orientations.[6] In summary, it is observed that the majority of children with gender dysphoria in childhood do not have gender dysphoria in adolescence or adulthood. In terms of sexual orientation, it is seen that there is a strong relationship between gender dysphoria in childhood and homosexual orientation or bisexuality in later years.
According to the ICD-10 diagnostic system, this table is called “transsexualism” in “sexual identity disorders.” The phrase “sexual identity disorder” was similarly used in the DSM-IV also. In DSM-5 (American Psychiatric Association, 2013), gender dysphoria is expressed as a significant discrepancy between the sex determined at birth and the gender experienced/expressed for at least 6 months, and in its translation into Turkish, the diagnosis is translated as “complaint (dissatisfaction) of sexual identity.”[7] Thus, the stigmatizing feature of the word disorder has been eliminated and the problems experienced by these individuals have been emphasized.
This development has also led to the transition from identity-based health care to dysphoria-based health care. Gender dysphoria is thought to be a seldom condition. The less number of studies published in this field prevent the exact degree of prevalence of this diagnosis from being known. The prevalence rating in DSM-5 (American Psychiatric Association, 2013) was between 0.005%–0.014% in adult men and 0.002%–0.003% in adult women. However, it remains unclear whether there has been an increase. The prevalence of this picture cannot be known, because no studies are investigating the epidemiology of gender dysphoria in Turkey.[8]
Individuals experiencing gender dysphoria may experience varying degrees of discrimination and violence due to gender expressions that do not conform to the normative values of society, similar to other sexual minorities, due to cultural differences, differences in basic rights, and understanding of freedom.[9] Individuals with gender dysphoria can experience physical and verbal violence, have high unemployment rates relative to society as a whole, tend to be abandoned by a heterosexual partner when they start the gender transition process and have difficulty finding a new partner among others, all these life experiences can further increase the psychological well-being and life satisfaction quality of gender dysphoria, limiting the psychological functionality of people with gender dysphoria.[10]
A person experiencing this problem seeks to get rid of the primary and/or secondary sex characteristics of their own body due to the conflict, on the one hand, while on the other hand, they also want to have the primary and/or secondary sex characteristics of the other gender. For this reason, a person with “gender dysphoria” or identified as “transsexual” has a desire to receive hormonal and surgical treatment so that their body becomes suitable for their sexual identity.[11] People who constantly feel this distress in all aspects of life may seek medical intervention with the desire to make changes in their body in the direction of the opposite gender.
Recent multidimensional treatments focus on the distress caused by a discrepancy between a person's sexual identity and biological characteristics and aim to reduce gender dysphoria.[12] During the follow-up process, some of the individuals may not want to change their gender or may have a comfortable fit with their own sexual identity. For this reason, the treatment should be individual-specific.[13] In psychotherapy, the goal is not to change a person's sexual identity, but to provide a state of spiritual well-being and improve the quality of life.[14]
Two-dimensional measurements of gender dysphoria are widely used in clinical settings. Generally, it is considered whether or not it meets the symptoms. On the other hand, gender dysphoria questionnaire (GIDQ), argue that dysphoria is a dimensional measurement. On the other hand, GIDQ, argue that dysphoria is a dimensional measurement. At least some of these individuals do not express a desire for a full gender reassignment surgery, that is, both hormone therapy and genital surgery. Therefore, such individuals may have a low threshold value for the diagnosis of “Gender Dysphoria” of the DSM-V. It is clinically useful to assess the degree of gender dysphoria from those who experience mild symptoms to those who experience severe symptoms or to distinguish between those below the threshold.
When the literature is examined, the GIDQ is found which was developed by Deogracias et al. 2007.[15] It is stated that 13 items of this scale, consisting of 27 items, are subjective, 9 are social, 3 are somatic and 2 are formed by taking into account socio-legal indicators. This scale, which has two separate forms for adults and adolescents and whose participation frequency is determined as “Always,” “Frequent,” “Sometimes,” “Rare,” “Never,” is of the 5-item Likert type and reveals the level of gender dysphoria by applying “female version” to women and “male version” to men according to the biological sex.
The GIDQ is a scale that has been answered by participants over the last 12 months, and its applicability is quite comprehensive as it is developed with heterosexual and nonheterosexual individuals, with individuals who have not been diagnosed with Gender Dysphoria, and individuals with homosexual orientation, heterosexual and bisexual orientation who have been diagnosed with Gender Dysphoria. In the original studies of this scale, the internal consistency coefficient Cronbach Alpha value was found to be. 97. Accordingly, it is thought that this scale, which researchers suggest best explains the extent of the problems experienced by transgender people, to contribute to clinical studies by bringing it to the national literature. Biological Sex, Sexual Identity, and Sexual Orientation are predicted to be three separate parameters.[16] Given that biological sex is the genetic equivalent, and sexual identity and sexual orientation are not genetically confirmed, we should point out that this scale only measures sexual identity dysphoria. Therefore, it does not cover the definition of homosexuality since homosexuality can also be “native” regardless of sexual identity.
The fact that the concepts of sexual identity and gender dysphoria have become more important all over the world and in Turkey has led clinicians to need powerful measuring tools to evaluate and comment on this structure. Although there are validity and reliability studies on the concepts of sexual identity and gender dysphoria in foreign literature.[17] there is no scale of this feature in Turkey yet. In line with these general evaluations, the research aimed to adapt the adult form (AF) of the GIDQ developed by Deogracias et al. to Turkish by conducting validity and reliability analyses and linguistic equivalence studies.
| Methods | | |
The ethics committee approval has been obtained from the Uskudar University Noninterventional Research Ethics Committee (61351342/2020/459).
GIDQ AF validity and reliability studies were carried out with a working group of three groups, taking the sample of the original study into account. Accordingly, the first group consists of 315 university students who are selected regardless of their sexual identity and orientation. The second group consisted of 53 transgender-oriented participants who were undiagnosed, whose sexual identity and orientation were heterosexual, homosexual, and bisexual. Thus, 368 people participated in the study. The third group was formed by individuals with a tendency towards Gender Dysphoria. Accordingly, the first form of the scale after linguistic equivalence studies were carried out was applied to 315 people, and 33 people with an average score of >2.5 points were selected from the scale and taken into the third group.
When creating the study group, the participant characteristics of the Deogracias et al. study were taken into account and the participants' sexual orientation and dysphoria levels were considered decisive in groupings.[15] The workgroup is given in [Table 1].
When [Table 1] is examined, 315 university students participated in the study. 276 reported their sexual orientation and 39 did not. In the trans-oriented group, 53 participants stated their sexual orientation in full. A total of 58 nonheterosexual individuals participated in the study.
When the biological sex of the participants is examined, 81.5% are female and 18.5% are male and their age varies between 18 and 62. The average age of the participants was 29.34.
| Measurement Instrument | | |
The research data required for validity studies were collected with the “Gender Identity / Gender Dysphoria Questionnaire (GIDQ)” developed by Deogracias et al. 2007.[15] The scale consists of 27 items. There is a male and female version of the AF of the scale, which is reported to consist of 13 subjective items, 9 social, 3 somatic, and 2 socio-legal indicators. Accordingly, the appropriate scale form is applied according to the biological gender. Items in the range of 1–2, 5–10, 16, and 24–27 are subjective determinants of gender dysphoria; social determinants of items in the range of 3–4, 11, 13–15, and 17–19; somatic determinants of items in the range of 20–22; items 12 and 23 have taken their place as socio-legal determinants. In the evaluation of the scale, items 1, 13, and 27 must be scored in reversely.
Items concerning subjective determinants of Gender Dysphoria express one's thoughts about gender dissatisfaction. The items that measure social determinants express the opinions of others about the person and relate to the pressure of others' thoughts on the person. Somatic determinants express the degree to which the person is prone to the changes he/she wants to make in his/her body. Socio-legal determinants are related to the law and measure the dissatisfaction of gender practices in official institutions or structures.
Responses to the GIDQ range from 1 (Never) to 5 (Always), with the lowest score being 27 and the highest score being 135. Accordingly, as if the score from the sum of GIDQ increases, it is evaluated that the trend of Gender Dysphoria increases. In a study by Deogracias et al., the Cronbach Alpha value was 0.97 as the internal consistency coefficient of the scale developed with 462 participants.[15]
| Implementation | | |
Before the stage of translating and applying the scale into Turkish, permission was obtained by mail from researchers who developed the original scale. Later the process was started.
Translation study
To obtain the Turkish form of GDS-AF, the items of the original scale were translated into Turkish primarily by an expert who is proficient in Turkish and English. It was then checked by two field experts who knew both languages well.
Implementation of scale
GIDQ's research patterns and content approval is given for ethical compliance by the Ethics Committee of Uskudar University Noninterventional Researches with the issue 61351342/2020/459. Data collection took place in November in the group of university students in 2020 and in December in transgender individuals. The data were obtained by people aged 18 and over, filling out surveys online on their own, according to the volunteer principle. The questions in the survey form were formed using scale items following a translation study with experts together.
After the approval of the ethics committee, the forms prepared were applied in print out to 12 people who spoke English and Turkish in two languages 3 weeks apart, a linguistic equivalence study was carried out and the comprehensibility of the questions was tested. The informed consent form and survey questions were transferred to the Google Forms program, after which candidates with the appropriate characteristics were called to participate via social media, E-mail, and phone messages. Surveys remained available for about a month after they were shared. Participants' answers were saved simultaneously by the Google Forms program to the Excel file. The quality of the data is evaluated according to consistency, missing data, excess data, invalid data criteria. Via this method, a valid database is obtained for the analysis process. The data of a total of 315 people were subjected to validity and reliability analyses. An average of 12 min was enough for the survey to be completed by the participants.
Data analysis
In GIDQ's linguistic equivalence studies, consistency between Turkish and English form applications was tested by using the Pearson correlation coefficient. Factor analysis was applied to test the structure validity of GIDQ. The stages specified in the literature were followed in factor analysis applications.[18],[19] In reliability studies, the Cronbach Alpha internal consistency coefficient was tested. In addition, internal consistency reliability was examined with item-total correlation coefficients, mean, standard deviation (SD) values in line with the literature.[20],[21] SPSS 26 program was used to analyze the data.
| Results | | |
Linguistic equivalence studies of gender dysphoria scales-adult form
English and Turkish form of GIDQ consistency was found after applications to adult individuals by calculating the Pearson correlation coefficient. Accordingly, several information suggested about the time interval between the two applications is contained in the literature. According to Özgüven, the time interval of two to four weeks is sufficient.[22] Ergin argues that it should be between 3 and 6 weeks.[23] English and Turkish speaking university students with 3 weeks between the applications were found to be sufficient. First, the original form of the scale was applied to 12 students, followed by a Turkish translation after 3 weeks. Relationships have been determined with Pearson Correlation coefficients between the two applications. The relationship coefficient of each item varies between 0.57 and 0.88.
Turkish and English forms between the total scores of the relationship coefficient found as (r: 0.67; P < 0.001) is also positive and significant. In addition, based on the results of the dependent Group t-test (t: 1.44; df: 6; P > 0.05), it was also determined that there were no significant differences between both applications. The results were interpreted as that the amount between the two applications of the scale was acceptable and language equivalence was achieved in the forms.
Validity and reliability studies of gender dysphoria scales-adult form
Kaiser Meyer Olkin's (KMO) sample coefficient and the Bartlett test were examined primarily for the appropriateness of the data for factor analysis when starting validity and reliability studies. Accordingly, the sample coefficient KMO value was found to be 0.93. The Bartlett test result was also found to be significant (X2 = 8123.315, SD: 300, P = 0.000). In line with these values, it was decided that the data set was suitable for exploratory factor analysis (EFA), and EFA was applied.
As a result of the EFA, it was seen that the items were collected in one factor. Item factor loads were taken > 0.30 on the original scale, so the single-factor structure emerged, and 27 items with a self-value (eigenvalue) of 16.54 built up 61.3% of the total variance. In the Turkish version, 25 items with a self-value of 12.951 explained 51.80% of the total variance. The factor load of the 2 items on the scale remained below. Accordingly, the EFA result of the sequencing of items 13 and 27 concluded that the items were compatible with the original scale. Item factor loads are given in [Table 2].
As a result of the carried out EFA, the scale form consisting of 25 items is rated as “never,” “rare,” “sometimes,” “often,” and “always” in the 5-item Likert type. The first item on the scale is scored in reversely. Thus, the application form “GIDQ” is included in [Appendix 1]. In addition, the line chart (scree plot) test, which is often used to determine the number of factors, is as in [Figure 1].
In calculations to test the reliability of GIDQ, the Cronbach Alpha internal consistency coefficient was found to be. 89. Thus, it is understood that the scale consisting of 25 items is reliable. Items 1st, 2nd, 5th, 6th, 7th, 8th, 9th, 10th, 16th, 24th, 25th, 26th as the subject determinants, 3rd, 4th, 11th, 14th, 15th, 17th, 18th, 19th items as the social determinants, 20th, 21st, 22nd items as the somatic determinants, and 12th, 23rd items as the socio-juridical determinants of gender dysphoria took their place within the scale. Item 1 on the scale must be scored in reverse, as in the original. The factor load values of items 13 and 27 on the original scale were not measured because they were found to be low in the Turkish adaptation studies (<0.30). Thus, the GIDQ in 5-item Likert type consisting of 25 items, and one factor has emerged. Two separate scale forms have been built up for men and women in the implementation of the scale [Appendix 1].
As a result of validity and reliability studies, the average scores of the participants from the scale were calculated by collecting each item and dividing it by 25. Accordingly, the average scores of three groups of heterosexual orientations, nonheterosexuals and those prone to Gender Dysphoria were obtained, and the size of the groups was revealed as in [Table 3] using the effect size (d) calculation developed by Cohen (1988).[24]
During the analyzes, heterosexual male group, nonheterosexual group of men, heterosexual group of women, nonheterosexual group of women, a heterosexual group prone to gender dysphoria, and nonheterosexual group prone to gender dysphoria were referenced.
The results of the variance analysis with three gender-oriented groups (heterosexual ones, nonheterosexual ones, gender dysphoria-prone ones) were significant (F = 639,741; P < 0.001). This difference was determined in accordance with Cohen's (d) effect size calculation and scale scores, taking into account the biological gender. Independent Group t-test was applied between the groups and the significance was looked at by referring to heterosexual women and heterosexual men in the groups.
Accordingly, nonheterosexuals in the female group have a high effect in terms of gender dysphoria compared to heterosexual ones (d = 0.88; >0.8). The group with the propensity for gender dysphoria and nonheterosexual women were found to have a higher impact than heterosexual women [Figure 2]. | Figure 2: Frequency distributions of women's scores. When evaluating points in horizontal lines, the breakpoint is considered as a medium value of 2.5
Click here to view |
As a result of variance analysis of three groups by gender, men's sexual orientation built up a difference [Figure 3]. As a result of variance analysis of three groups by gender, men's sexual orientation built up a difference (d = 1.31; >8). | Figure 3: Frequency Distributions of Men's Scores. When evaluating points in horizontal lines, the breakpoint is considered as a medium value of 2.5
Click here to view |
Looking at the average scores of all three groups, the average score of the third group (Gender Dysphoria-Prone Group) was 2.94, with those with the scale scores above 2.5 (midpoint). The score of 9 heterosexual people in the group of 33 people was 3.32. The average score of 24 transgender and bisexual-oriented people was 2.80. In this group, some individuals reported identification as trans, and the scale score (average score) of 16 trans-oriented people was 3.18. 8 people did not specify identification.
| Discussion | | |
In this study, the “GIDQ” developed by Deogracias et al. with 462 participants has been adapted to Turkish. Further verification of the same scale by Singh et al. found that it detected gender dysphoria in both adolescents and adults with excellent sensitivity and accuracy rates compared to the control groups.[25]
Within the scope of validity and reliability studies, EFA was carried out taking into account the original scale stages and it was seen that the single-factor structure provided the appropriateness in terms of factor loads in the Turkish version also. Thus, the 27-item single-factor structure of the original scale explained 61.3% of the total variance, while the scale adapted to Turkish consisted of 25 items and a single factor, accounting for 51.8% of the total variance. Cronbach alpha internal consistency coefficient value and 0.89 indicates that the scale adapted to Turkish is reliable.
In the group of university students who built up the study, the measurement of gender dysphoria without separating men or women shows a low level as expected (X = 1.29). Considering that the minimum average score to be taken from the scale is 1 and the maximum is 5, the value of 1.29 indicates a low level. The average score of 53 transgender individuals was 2.26 when calculated. When the full mid-point value of the scale is 2.5, it is seen that transgender people have close to moderate gender dissatisfaction.
On the other hand, a sample of 368 people from the trans-oriented group (n = 53) tested for signability between university students (n = 315) and groups that were “heterosexual,” “nonheterosexual” and “prone to gender dysphoria,” which were built up taking biological sex and sexual orientation into account. Accordingly, the significant variance analysis results (P < 0.001) by including three groups according to the average scores of the GIDQ revealed the difference between the groups. The results of the independent group t-test, which were divided by gender and grouped in pairs (heterosexual, nonheterosexual), had a high effect when the effect size calculations developed by Cohen (d) were performed.
Nonheterosexual women (n = 30) were found to have higher gender dissatisfaction than heterosexual women. Although average scores generally show low levels of gender dissatisfaction with women, independent group t-test and impact size (d) analyses revealed a high impact in nonheterosexual women (d > 0.8).
Comparison of men found that nonheterosexual men, including transgender-oriented individuals, had higher gender dissatisfaction. The average scale score for heterosexual men was 1.42, while transgender men had a score of 2.15. Difference test and impact magnitude analyses revealed that transgender men tended to be highly dissatisfied with gender dissatisfaction (d = 1.31; >0.8).
On the other hand, people with an average score of >2.5 in the study who were prone to gender dysphoria made up the third group. The average score of this group was found to be high in heterosexuals. However, considering that only 9 people make up the heterosexual group, it turns out that this number is limited for the difference test. When we evaluate this group together as heterosexual and homosexual (n = 33), the average score is 2.94. We can state that this value is above the mid-point value of the scale of 2.5.
In a study of the psychometric characteristics of GIDQ on a group of high school students living in Iran, factor analysis of the scale was conducted using both descriptive and validating factor analyses, and explanatory factor analysis results showed that the four factors on the scale accounted for 63.44% of the total variance. The validation factor analysis has shown that four factors have good compatibility. Test-retest and internal consistency reliability were determined as 0.93 and 0.92, respectively.[26] A study of validity and reliability of the GIDQ conducted in Italy found that the scale showed a single factor structure as a result of applying it to those with sexual identity disorders and volunteers, and it was reported that it can be used to evaluate gender dysphoria.[27]
As a result, in our research, the single-factor structure of the GIDQ adapted to Turkish by conducting validity and reliability studies ended well by eliminating 2 items, the Cronbach Alpha internal consistency coefficient value to be, 89, showed that the 25-item GIDQ is reliable. However, recommendations may be given to future research in accordance with several limitations found in the study. First, validity and reliability can be looked at again in future studies, including a group of patients diagnosed with gender dysphoria, and compared with the values here. Second, more individuals can be reached based on biological gender assigned by birth in trans-oriented individuals. In this way, the difference between men and women in this group can be looked at again. In this study, “GIDQ,” which was first translated into Turkish, was included in the literature as a valid and reliable scale.
GIDQ's participation in the literature will enable many new studies on gender dysphoria. Researches were carried out on cases with gender dysphoria in foreign literature. Fisher et al. evaluated the body dissatisfaction, self-esteem risk, and psychological functionality of two groups of adolescents with and without gender dysphoria on scales including GIDQ, and found that the group with gender dysphoria experienced significantly higher levels of body dissatisfaction, worse psychological functionality, higher levels of depression and anxiety, and social problems. Worse, the group with gender dysphoria reportedly found significant the death more attractive and hated life.[28]
In another study, functional magnetic resonance imaging was applied and brain activation patterns were evaluated by giving “gender face separation” to two trans-traited and nontransgender groups whose psychometric characteristics were detected using GIDQ, Body Dissatisfaction Questionnaire, and Symptom Checklist-90-R. With the results here, it was first thought that there may be a possible specific relationship between gender dysphoria and neural pathways.[29]
GIDQ can be used in research related to the neurological, psychological, or biological characteristics of cases with gender dysphoria, as well as to investigate gender dysphoria in many neurodevelopmental disorders. In a study comparing 309 patients with autism spectrum disorder (ASD) with 261 patients without ASD diagnosis using GIDQ, it was reported that gender dysphoria was significantly higher in the group diagnosed with ASD, so clinicians working with ASD-diagnosed cases should be vigilant about gender diversity in this group.[30] Another study of 100 women with Borderline personality disorder with GIDQ found no gender dysphoria in any of the cases.[31]
At the end of the research, the GIDQ developed by Deogracias et al. was adapted into Turkish. It is thought that it would be appropriate for clinicians and researchers working in this field to be used in the evaluation and follow-up stages.
Patient informed consent
Informed consent was obtained.
Ethics committee approval
The ethics committee approval has been obtained from the Uskudar University Noninterventional Research Ethics Committee (61351342/2020/459).
Financial support and sponsorship
No funding was received.
Conflicts of interest
There are no conflicts of interest to declare.
Author contribution subject and rate
Nevzat Tarhan (%20): Contributed with theoretical background and control whole manuscript.
Emel Sarı Gökten (%20): Contributed with theoretical background and wrote the Introduction and Conclusion.
Aylin Tutgun Unal (%40): Design the research, data analysis and wrote the method and analysis manuscript.
Ayşe Şahin (%20): Contributed with data collect and wrote the Introduction.
| References | | |
| 1. | Polat A, Alioğlu F. -9. Gender dysphoria: Kocaeli University Hospital experience. J Anatol Psychiatry 2019;20:101  |
| 2. | Özsungur B. Gender identity development and gender identity disorder: Psychosocial characteristics. Turkish Journal of Child and Adolescent Mental Health 2010; 17:163-74. |
| 3. | Sadock B, Sadock V. Kaplan and Sadock's Concise Textbook of Clinical Psychiatry. 3 rd ed. USA, Philadelphia: Lippincott Williams Wilkins; 2008. |
| 4. | Zucker KJ. Gender identity disorder in children and adolescents. Annu Rev Clin Psychol 2005;1:467-92. |
| 5. | Green R. Gender identity in childhood and later sexual orientation: Follow-up of 78 males. Am J Psychiatry 1985;142:339-41. |
| 6. | Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ. A follow-up study of girls with gender identity disorder. Dev Psychol 2008;44:34-45. |
| 7. | Köroğlu E. American Psychiatric Association Mental Disorders Diagnostic and Statistical Manual. 5th press (DSM 5). Ankara, Turkey: Physicians Publications Association; 2013. |
| 8. | Turan Ş, Aksoy PC, İnce E, Sakallı A, Emül H, Duran A. Sociodemographic and Clinical Characteristics of Transsexual Individuals who Applied to a Psychiatry Clinic for Sex Reassignment Surgery. Turkish Journal of Psychiatry 2015;26:153 60. |
| 9. | Başar K, Öz G. Resilience in individuals with gender dysphoria: Association with perceived social support and discrimination. Turk Psikiyatri Derg 2016;27:225-34. |
| 10. | Özata B, Yüksel Ş, Avayu M, Noyan H, Yıldızhan E. Effects of Gender Reassignment on Quality of Life and Mental Health in People with Gender Dysphoria. Turkish Journal of Psychiatry 2018;29:11 21. |
| 11. | Vujovic S, Popovic S, Sbutega-Milosevic G, Djordjevic M, Gooren L. Transsexualism in Serbia: A twenty-year follow-up study. J Sex Med 2009;6:1018-23. |
| 12. | Schneider C, Cerwenka S, Nieder TO, Briken P, Cohen-Kettenis PT, De Cuypere G, et al. Measuring Gender Dysphoria: A multicenter examination and comparison of the utrecht gender dysphoria scale and the gender identity/gender dysphoria questionnaire for adolescents and adults. Arch Sex Behav 2016;45:551-8. |
| 13. | Bockting W, Knudson G, Goldberg, J. Counseling and mental health care for transgender adults and loved ones. Int J Transgend Health 2006;9:35-82. |
| 14. | Keskin N, Yapça G, Tamam L. Transsexualism: Clinical Features and Legal Issues. Current Approaches in Psychiatry 2015;7:436 47. |
| 15. | Deogracias JJ, Johnson LL, Meyer-Bahlburg HF, Kessler SJ, Schober JM, Zucker KJ. The gender identity/gender dysphoria questionnaire for adolescents and adults. J Sex Res 2007;44:370-9. |
| 16. | Bering J. The third gender. Sci Am Mind 2010;21:60-3. |
| 17. | Galupo MP, Pulice-Farrow L. Subjective ratings of gender dysphoria scales by transgender individuals. Arch Sex Behav 2020;49:479-88. |
| 18. | Bryman A, Cramer D. Quantitative Data Analysis with SPSS for Windows: A Guide for Social Scientists. USA, New York: Routledge; 1997. |
| 19. | Tezbaşaran AA. Likert Type Scale Development Guide. Ankara, Turkey: Turkish Psychological Association Publications; 1997. |
| 20. | Büyüköztürk Ş. Sosyal Bilimler için Veri Analizi El Kitabı. Ankara: Pegem Akademi Yayıncılık; 2002. |
| 21. | Preacher KJ, MacCallum RC. Exploratory factor analysis in behavior genetics research: Factor recovery with small sample sizes. Behav Genet 2002;32:153-61. |
| 22. | Özgüven İE. Psikolojik Testler. Ankara: Yeni Doğuş Matbaası; 1994. |
| 23. | Ergin DY. Validity and reliability in scales. Marmara University Ataturk Education Faculty Journal of Educational Science 1995;7:125 48. |
| 24. | Cohen J. Statistical Power Analysis for the Social Sciences. 2 nd ed. USA, New Jersey: Hillsdale, Lawrence Erlbaum Associates Purblishing; 1998. |
| 25. | Singh D, Deogracias JJ, Johnson LL, Bradley SJ, Kibblewhite SJ, Owen-Anderson A, et al. The gender identity/gender dysphoria questionnaire for adolescents and adults: Further validity evidence. J Sex Res 2010;47:49-58. |
| 26. | Soltanizadeh M, Nemati N, Latifi Z. Psychometric properties of gender identity/Gender dysphoria questionnaire for adolescents and adults in female adolescents. J Res Psychol Health 2020;13:101-14. |
| 27. | Prunas A, Mognetti M, Hartmann D, Bini M. The evaluation of gender dysphoria: The Italian version of the gender identity / Gender dysphoria questionnaire. Riv Sessuol Clin2013;20:35 51. |
| 28. | Fisher AD, Ristori J, Castellini G, Sensi C, Cassioli E, Prunas A, et al. Psychological characteristics of Italian gender dysphoric adolescents: A case-control study. J Endocrinol Invest 2017;40:953-65. |
| 29. | Fisher AD, Ristori J, Castellini G, Cocchetti C, Cassioli E, Orsolini S, et al. Neural correlates of gender face perception in transgender people. J Clin Med 2020;9:1-20. |
| 30. | George R, Stokes MA. Gender identity and sexual orientation in autism spectrum disorder. Autism 2018;22:970-82. |
| 31. | Singh D, McMain S, Zucker KJ. Gender identity and sexual orientation in women with borderline personality disorder. J Sex Med 2011;8:447-54. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]
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