The Mediating Role of Rumination in the Relationship Between Brain-Behavioral Systems and Gender Dysphoria in Adolescent

Abstract

Background: While a potential association between brain-behavioral systems and gender dysphoria has been suggested in adolescent populations, the specific mechanisms driving this relationship have yet to be fully elucidated. Objectives: The present study aimed to investigate whether rumination mediates the relationship between brain-behavioral systems and gender dysphoria specifically within a cohort of adolescent girls. Methods: A descriptive correlational design was utilized in this study, with the target population consisting of all female adolescents aged 13 to 18 years residing in Ahvaz, Iran. A sample of 316 participants was obtained through a multi-stage cluster random sampling procedure conducted in 2024. This involved randomly selecting two educational districts, then randomly choosing one secondary school from each district, followed by the random selection of four classrooms within each school. Data collection was facilitated by the administration of questionnaires designed to measure gender dysphoria, brain-behavioral systems, and rumination. Structural equation modeling (SEM) was subsequently employed for data analysis to examine the relationships between these variables, utilizing the SPSS software platform. Results: The analysis revealed a statistically significant positive direct association between behavioral inhibition and gender dysphoria among adolescents, concurrently demonstrating a statistically significant negative direct association between behavioral activation and gender dysphoria (P < 0.001). Moreover, a statistically significant positive association was identified between rumination and gender dysphoria in the adolescent sample (P < 0.001). Critically, the findings further substantiated a statistically significant indirect effect of both behavioral inhibition and behavioral activation on gender dysphoria, mediated through rumination (P < 0.001). Conclusions: This study demonstrates that rumination mediates the relationship between brain-behavioral systems and gender dysphoria in adolescent girls, suggesting that interventions targeting rumination may be effective in reducing gender dysphoria. The findings highlight the importance of considering psychological pathways, such as rumination, in understanding and addressing gender dysphoria in adolescence.