23 Defining Gender Dysphoria
Defining Gender Dysphoria
Gender dysphoria, formerly classified as gender identity disorder (GID) in the previous version of the DSM (DSM-IV-TR), is the formal diagnosis used by psychologists and physicians to describe people who experience significant dysphoria (discontent) with the sex and gender they were assigned at birth. Gender identity refers to one’s own sense of themselves as a woman, man, or other gender. Most children develop a gender identity that is consistent with their sex assigned at birth. In some cases, however, children or adolescents — sometimes even those as young as three or four years old — have a strong sense that they have been trapped in a body of the wrong sex. Many people who are diagnosed with gender dysphoria identify as transgender, genderfluid, or otherwise gender non-conforming in some way; however not everyone who identifies as transgender or gender non-conforming experiences gender dysphoria. About 0.6% of adults in the US identify as transgender, while rates of gender dysphoria are smaller, around .01%
Symptoms of gender dysphoria in children include preferences for opposite sex-typical toys, games, or activities; great dislike of their own genitalia; and a strong preference for playmates of opposite sex children. These children report feeling that they are a different gender than the one they were assigned, and they can experience social isolation from their peers, anxiety, loneliness, and depression. Transgender children are also more likely to experience harassment and violence in school, foster care, residential treatment centers, homeless centers, and juvenile justice programs than other children (e.g., Norris & Orchowski, 2020). However, there are protective factors that can promote resilience among transgender and gender nonconforming youth, including family and social support and school safety (Tankersley et al., 2021).
Gender nonconformity is not the same thing as gender dysphoria. According to the DSM-5 (American Psychiatric Association, 2013), the critical element of gender dysphoria is “clinically significant distress”. Adults with gender dysphoria are at increased risk for stress, isolation, anxiety, depression, poor self-esteem, and suicide (Dhejne et al., 2016); however, for many individuals, mental health symptoms may improve following the treatment of gender dysphoria (e.g., cross-sex hormonal treatment; Costa & Colizzi, 2016).
DSM-5 Diagnostic Criteria
In 2013, the diagnosis was renamed from “gender identity disorder” to “gender dysphoria” after criticisms that the former term was stigmatizing. The DSM-5 also moved this diagnosis out of the sexual disorders category and into a category of its own. In order to be diagnosed with gender dysphoria, a person must experience, for at least 6 months, a noticeable difference between how they experience/express their own gender and the gender which they were assigned at birth. Symptoms related to this may include the expressed desire for others to treat or perceive them as another gender; discomfort with their genitals or sex characteristics; wishing these genitals or sex characteristics were different or aligned with another gender; and/or a strong sense of being another gender despite how others perceive them. This discrepancy must cause significant impairment in social, occupational, school, or daily life functioning.
The American Psychiatric Association permits a diagnosis of gender dysphoria in adolescents or adults if two or more of the following criteria are experienced for at least six months’ duration:
A strong desire to be of a gender other than one’s assigned gender
A strong desire to be treated as a gender other than one’s assigned gender
A significant incongruence between one’s experienced or expressed gender and one’s sexual characteristics
A strong desire for the sexual characteristics of a gender other than one’s assigned gender
A strong desire to be rid of one’s sexual characteristics due to incongruence with one’s experienced or expressed gender
A strong conviction that one has the typical reactions and feelings of a gender other than one’s assigned gender
In addition, the condition must be associated with clinically significant distress or impairment.
The diagnosis for children has been separated from that for adults. The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing, or to express it in the event that they have insight. A post-transition specifier was also added for transgender individuals who have transitioned to their chosen gender (i.e., undergone hormonal or surgical procedures to alter their body in a way that matches their experienced gender identity). This specifier helps to ensure post-transition individuals can continue to receive ongoing hormonal or other treatment as needed.
Controversy Surrounding the Diagnosis
The previous diagnosis of gender identity disorder (GID) caused a great deal of controversy. Many transgender people and researchers supported the declassification of GID, arguing that the diagnosis pathologizes a natural form of gender variance, reinforces the binary model of gender (i.e., the idea that there are only two genders and that everyone must fit neatly into one of these two genders), and can result in stigmatization of transgender individuals. The official reclassification of gender dysphoria as a disorder in the DSM-5 may help resolve some of these issues, because the term “gender dysphoria” applies only to the discontent experienced by some persons resulting from gender identity issues, rather than suggesting that their identity is disordered.
Advantages and disadvantages exist to classifying gender dysphoria as a disorder, however. Many people argue that the distress associated with gender dysphoria is not caused by any disorder within the individual, but by difficulties encountered from social disapproval of transgender identities and alternative genders. As such, they argue that any form of diagnosis is still stigmatizing and places the “problem” unnecessarily on the individual, rather than on society. However, because gender dysphoria is classified as a disorder in the DSM-5, many insurance companies are willing to cover some of the expenses related to gender-confirming therapy. Without the classification of gender dysphoria as a medical disorder, some gender-confirming therapies may be viewed as cosmetic treatment—rather than medically necessary treatment for many transgender individuals—and thus may not be covered.
Key Takeaways
Dysphoria
A state of feeling unwell or unhappy; a feeling of emotional and mental discomfort and suffering from restlessness, malaise, depression, or anxiety.
Gender dysphoria
The formal diagnosis used by psychologists and physicians to describe people who experience significant dysphoria (discontent) with the sex and gender they were assigned at birth.
Gender identity
One’s personal experience of one’s own gender; one’s personal sense of being a man, woman, non-binary, or any other gender.
Transgender
Having a gender identity which is different from the sex one was assigned at birth.
“Defining Gender Dysphoria” is adapted from Abnormal Psychology by Coursehero, used under CC BY-SA: Attribution-ShareAlike.
