Distress Profiles of Adolescents with Gender Dysphoria: A Cluster Analysis Approach

Gender dysphoric adolescents presenting to specialized gender identity services experience varying degrees of co-occurring mental health problems. However, few studies have examined how these symptoms may cluster into distinct patterns of psychological distress. This study examined subgroup differences in psychopathological characteristics in a clinical sample of 102 adolescents (74.5% natal females, M age = 16.08 years, SD = 1.54) with gender dysphoria. We used hierarchical cluster analysis to identify subgroups within our sample based on self-report measures on gender dysphoria, general psychopathology, body image, childhood trauma, levels of personality functioning, identity development, and items on perceived social support. This exploratory approach revealed three subgroups with distinct distress profiles. A “Low-Distress” cluster (29%) showed minimal psychopathological symptoms, with scores below clinical cut-offs on most measures and high levels of social support. A “Moderate-Distress” cluster (48%) showed significant internalizing psychopathology, moderate exposure to emotional maltreatment, and low to moderate impairment in personality functioning, but high levels of social support. A “High-Distress” cluster (23%) showed severe internalizing and externalizing psychopathology, high levels of childhood trauma on most subscales, severe impairments in personality functioning and identity development and low levels of social support. All clusters reported clinically significant gender dysphoria and poor body image. These findings highlight significant differences in distress profiles in this clinical sample and provide a basis for future research to validate this subgroup typology, examine their developmental trajectories, and inform individualized treatment approaches for adolescents with gender dysphoria.