This is an English translation of the Swedish report published by Socialstyrelsen (The National Board of Health and Welfare) in February 2020, titled ‘Utvecklingen av diagnosen könsdysfori’. The report examines the prevalence of gender dysphoria in Sweden, co-occurring psychiatric diagnoses, and suicide mortality rates among those diagnosed with gender dysphoria.

Foreword

The National Board of Health and Welfare has conducted a detailed analysis of the development and prevalence of diagnosed gender dysphoria in the Swedish population. This mapping includes consideration of concurrent psychiatric diagnoses, self-harming behaviour (including suicide attempts), and suicide mortality among people with gender dysphoria. The report is primarily intended for professionals who encounter individuals with gender dysphoria.

— Olivia Wigzell, Director General

Gender Dysphoria

A person with gender dysphoria has a pronounced experience that their gender identity does not align with the sex registered at birth. This often leads to significant distress.

Gender dysphoria is assessed by specialist psychiatric teams, including psychiatrists, psychologists, and social workers. The aim of the evaluation is to determine whether the person experiences gender dysphoria or whether other underlying causes better explain the sense of incongruence.

Three diagnostic codes are used today:
– ICD code F64.9: Unspecified gender identity disorder (preliminary diagnosis)
– ICD code F64.0: Transsexualism (confirmed gender dysphoria diagnosis)
– ICD code F64.8: Used for individuals identifying as non-binary

A confirmed gender dysphoria diagnosis may lead to gender-affirming treatment.

Prevalence and Incidence

In 2018, a total of 5,841 people in Sweden (0.06% of the population) had some form of gender dysphoria diagnosis (F64). Of these, 4,326 had the confirmed diagnosis (F64.0), and 574 had a diagnosis such as F64.8, often used for non-binary individuals.

The number of people seeking help for gender dysphoria continues to increase, which means the number of confirmed diagnoses is expected to rise as evaluations are completed. Approximately 70–80% of those with a preliminary diagnosis are later given a confirmed diagnosis (F64.0).

The sharpest increase has occurred among adolescents aged 13–17, especially those registered female at birth.

Concurrent Psychiatric Diagnoses

From 2016 to 2018, individuals with gender dysphoria had a higher prevalence of concurrent psychiatric diagnoses and self-harming behaviour (including suicide attempts) compared to the general population.

Autism spectrum disorder was particularly common among individuals with gender dysphoria. Other diagnoses, such as bipolar disorder and personality disorders, were also more prevalent in this group. Depression and anxiety disorders were significantly more common among young females with gender dysphoria than among their male counterparts.

An analysis comparing time periods before and after a preliminary gender dysphoria diagnosis found that those with pre-existing psychiatric diagnoses had an increased risk of self-harm and suicide attempts during the assessment period. However, receiving a confirmed diagnosis (F64.0) was associated with a lower risk of suicide or self-harming behaviour. It remains unclear whether the confirmed diagnosis or related treatments reduce the risk, or whether individuals who receive a confirmed diagnosis tend to have fewer psychiatric complications.

Suicide Mortality

Since 1998, a total of 6,334 people in Sweden have received a gender dysphoria diagnosis. Of these, 21 males and 18 females (sex registered at birth) died by suicide, representing 0.6% of the diagnosed population.

To assess suicide risk in people with gender dysphoria compared to the general population, standardised mortality ratios (SMR) were calculated. The SMR compares the observed number of suicides in this group with the expected number if they had the same risk as the general population. An SMR greater than 1 indicates a higher risk.

The SMR was 4.9 for males and 13.7 for females with gender dysphoria. Although this is elevated, the risk was even higher for individuals diagnosed with other severe psychiatric disorders, such as schizophrenia, substance abuse disorders, or personality disorders. Many of the individuals with gender dysphoria who died by suicide also had these additional diagnoses, suggesting these may be more direct contributors to suicide risk.

Summary Conclusions

Diagnosed gender dysphoria is increasing in the population, particularly among children and young adults. The sharpest increase has been observed in girls aged 13–17. This trend is expected to continue, which will require the healthcare system to be adequately resourced for long-term assessment and care.

Individuals with gender dysphoria have a significantly higher prevalence of psychiatric comorbidities, self-harming behaviours, and suicide attempts than the general population. These factors must be carefully considered during evaluation and treatment planning.

While suicide mortality is higher among individuals with gender dysphoria, many of those who died also had severe psychiatric disorders, which themselves are associated with substantially elevated suicide risk. Therefore, it is difficult to determine the extent to which gender dysphoria itself contributes to suicide risk, independent of these other conditions.