GENDER DYSPHORIA

10 Apr GENDER DYSPHORIA

Posted at 03:51h in Disorders and Behaviors by

What Is Gender Dysphoria?

The term “transgender” refers to a person whose sex assigned at birth (i.e. the sex assigned by a physician at birth, usually based on external genitalia) does not match their gender identity (i.e., one’s psychological sense of their gender). Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. Though gender dysphoria often begins in childhood, some people may not experience it until after puberty or much later.

People who are transgender may pursue multiple domains of gender affirmation, including social affirmation (e.g., changing one’s name and pronouns), legal affirmation (e.g., changing gender markers on one’s government-issued documents), medical affirmation (e.g., pubertal suppression or gender-affirming hormones), and/or surgical affirmation (e.g., vaginoplasty, facial feminization surgery, breast augmentation, masculine chest reconstruction, etc.). Of note, not all people who are transgender will desire all domains of gender affirmation, as these are highly personal and individual decisions.

It is important to note that gender identity is different from gender expression. Whereas gender identity refers to one’s psychological sense of their gender, gender expression refers to the way in which one presents to the world in a gendered way. For example, in much of the U.S., wearing a dress is considered a “feminine” gender expression, and wearing a tuxedo is considered a “masculine” gender expression. Such expectations are culturally defined and vary across time and culture. One’s gender expression does not necessarily align with their gender identity. Diverse gender expressions, much like diverse gender identities, are not indications of a mental disorder.

Gender identity is also different from sexual orientation. Sexual orientation refers to the types of people towards which one is sexually attracted. People who are transgender have the same diversity of sexual orientations as people who are cisgender (people whose sex assigned at birth matches their gender identity).

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)1 provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults.

The DSM-5 defines gender dysphoria in adolescents and adults as a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following:

    • A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
    • A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
    • A strong desire for the primary and/or secondary sex characteristics of the other gender
    • A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
    • A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
    • A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The DSM-5 defines gender dysphoria in children as a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months, as manifested by at least six of the following (one of which must be the first criterion):

    • A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender)
    • In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing
    • A strong preference for cross-gender roles in make-believe play or fantasy play
    • A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
    • A strong preference for playmates of the other gender
    • In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities
    • A strong dislike of one’s sexual anatomy
    • A strong desire for the physical sex characteristics that match one’s experienced gender

As with the diagnostic criteria for adolescents and adults, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

 

Terminology

  • Cisgender: Describes a person whose gender identity aligns in a traditional sense with the sex assigned to them at birth.
  • Gender diverse: An umbrella term describing individuals with gender identities and/or expressions that vary from expected developmental norms. This includes people who identify as multiple genders or with no gender at all.
  • Gender dysphoria: A concept designated in the DSM-5 as clinically significant distress or impairment related to a strong desire to be of another gender, which may include desire to change primary and/or secondary sex characteristics. Not all transgender or gender diverse people experience dysphoria.
  • Gender expression: The outward manifestation of a person’s gender, which may or may not reflect their inner gender identity based on traditional expectations. Gender expression incorporates how a person carries themselves, their dress, accessories, grooming, voice/speech patterns and conversational mannerisms, and physical characteristics.
  • Gender identity: A person’s inner sense of being a girl/woman, boy/man, some combination of both, or something else, including having no gender at all. This may or may not correspond to the gender assigned at birth.
  • Nonbinary: A term used by some individuals whose gender identity is neither girl/woman nor boy/man.
  • Sex/gender assigned at birth: Traditional designation of a person as “female,” “male,” or “intersex” based on anatomy (external genitalia and/ or internal reproductive organs) and/or biology (sex chromosomes and/or hormones). “Sex” and “gender” are often used interchangeably, but they are distinct entities. It is best to distinguish between sex, gender identity, and gender expression and to avoid making assumptions about a person regarding one of these characteristics based on knowledge of the others. This is sometimes abbreviated as AFAB (assigned female at birth) or AMAB (assigned male at birth).
  • Sexual orientation: Describes the types of individuals toward whom a person has emotional, physical, and/or romantic attachments.
  • Transgender: An umbrella term describing individuals whose gender identity does not align in a traditional sense with the gender they were assigned at birth. It may also be used to refer to a person whose gender identity is binary and not traditionally associated with that assigned at birth.

This information is courtesy of the American Psychiatric Association.

For more information and other topics, please visit:  The AMERICAN PSYCHIATRIC ASSOCIATION