Gender dysphoria was created as a distinct disorder in order to clarify that being transgender, or identifying as a gender different from the one at birth is not in itself a psychiatric disorder. Both gender identity issues and feelings of dysphoria may manifest in a variety of different ways. It is important to know that gender dysphoria is not the same as gender nonconformity, which refers to behaviors not matching the gender norms or stereotypes of the gender assigned at birth. Gender dysphoria is also not the same thing as being gay or lesbian. People with gender dysphoria have higher rates of mental health disorders. Some research says that 71% of people with gender dysphoria will have some other mental health diagnosis in their lifetime.

Gender Dysphoria Defined

Gender dysphoria involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender. People with gender dysphoria may often experience significant distress and/or problems functioning associated with this conflict between the way they feel and think of themselves (referred to as experienced or expressed gender) and their physical or assigned gender. The gender conflict affects people in different ways. It can change the way a person wants to express their gender and can influence behavior, dress and self-image.

Different Types of Gender Dysphoria

There are not different types of Gender dysphoria as listed in the Diagnostic and Statistical Manual of Mental Disorders. There is a differentiation between having gender dysphoria with a disorder of sex development and/or post-transition.

Gender Dysphoria Causes

There is no known direct cause of gender dysphoria, but genes, hormonal influences in the womb, and environmental factors are all suspected to be involved. 

Gender Dysphoria Symptoms

To be diagnosed with general Gender dysphoria in children, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1):

    1. 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).
    2. 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.
    3. A strong preference for cross-gender roles in make-believe play or fantasy play.
    4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
    5. A strong preference for playmates of the other gender.
    6. 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.
    7. A strong dislike of one’s sexual anatomy.
    8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.

B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.     

To be diagnosed with general Gender dysphoria in adolescents and adults, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following:

    1. 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).
    2. 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).
    3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
    4. A strong desire to be the other gender (or some alternative gender different from one’s assigned gender)
    5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
    6. 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).

B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.

 

How to Approach a Loved One:

There is not a perfect way to approach a loved one that is assumed or known has gender dysphoria. In children and adolescents it is important to take the lead from the individual, allow them to be who they feel they are, and get help if they need it.  A study of transgender teens found that more than 50 percent of transgender males and almost 30 percent of transgender females reported attempting suicide. It is important to provide support to a loved one that is experiencing gender dysphoria and continue to be informed on the best ways to support them.

Types of Gender Dysphoria Treatment

The focus of treatment for gender dysphoria focuses on alleviating a person’s distress that surrounds their gender identity. It can be common for this distress to lead to anxiety and/or depression which may also need to be treated. A child’s treatment typically involves a multi-disciplinary team of health care professionals, which may include a pediatrician, a psychiatrist, other mental health professionals, a pediatric endocrinologist (specialists in hormone conditions in children) and an advocate.

Psychotherapy

In individual therapy, a person experiencing gender dysphoria can explore the feelings and distress and learn the tools to cope with it. The goal of therapy is not to change how an individual feels about their gender. Through therapy, individuals can also work with their families or significant others, to help them determine the best way to shape their gender expression for the healthiest outcome. Some people choose to take steps to bring their physical appearance in line with their gender and they may change the way the dress or go by a different name. These changes in an individual’s life are also topics that can be discussed in therapy. Parents of children with gender dysphoria may also benefit from counseling. Peer support groups for adolescents and adults and parent/family support groups can also be helpful.

Puberty Blockers

An individual that is in the early stages of puberty with gender dysphoria may take prescribed hormones (like testosterone or estrogen) in order to suppress the upcoming physical changes that their body naturally will develop. It is important to speak with a medical professional as well as a mental health professional before taking these hormones.

Hormones

In order to develop like the desired gender of the individual, some teens or adults may take hormones like testosterone or estrogen in order to develop the sex traits they identify with.

Surgery

In some cases people choose to have complete sex-reassignment surgery. Others may choose to have certain procedures done in order to look like their desired gender.

Medication  

Medication may be used to treat other related disorders that can be accompanied with gender dysphoria like anxiety and depression which can include antidepressants and anti-anxiety medication. These medications may have side effects and taking them can lead to tolerance, withdrawal symptoms, and dependence, so it is important that you consult with a physician before starting or stopping these medications.

Differences Between Common Disorders

There are other disorders that may resemble general Gender dysphoria, so it is important to differentiate the difference between common disorders or behaviors that may get confused with this disorder.

  • Nonconformity to gender roles- Gender dysphoria should be distinguished from simple nonconformity to stereotypical gender role behavior by the strong desire to be of another gender than the assigned one by the extent and pervasiveness of gender-variant activities and interests. The diagnosis  is not meant to merely describe nonconformity to stereotypical gender role behavior (e.g., “tomboyism” in girls, “girly-boy” behavior in boys, occasional cross-dressing i adult men).
  • Transvestic disorder- Transvestic disorder occurs in heterosexual (or bisexual) adolescents and adult males (rarely in females) for whole cross-dressing behavior generates sexual excitement and causes distress and/or impairment without drawing their primary gender into question. It is occasionally accompanied by gender dysphoria. An individual with transvestic disorder who also has clinically significant gender dysphoria can be given both diagnoses.
  • Body dysmorphic disorder- An individual with body dysmorphic disorder focuses on the alteration or removal of a specific body part because it is perceived as abnormally formed, not excuse it represents a repudiated assigned gender. When an individual’s presentation meets criteria for both gender dysphoria and body dysmorphic disorder, both diagnoses can be given. Individuals wishing to have a healthy limb amputated (termed by some body integrity identity disorder) because it makes them feel more “complete” usually do not wish to change gender, but rather desire to live as an amputee or a disabled person.
  • Schizophrenia and other psychotic disorders- In schizophrenia, there may rarely be delusions of belonging to some other gender. In the absence of psychotic symptoms, insistence by an individual with gender dysphoria that he or she is of some other gender is not considered a delusion. Schizophrenia (or other psychotic disorders ) and gender dysphoria may co-occur.
  • Other clinical presentations- Some individuals with an masculinization desire who develop an alternate, nonmale/ nonfemale gender identity do have a presentation that mets criteria for gender dysphoria. Some males seek castration and/or penectomy for aesthetic reasons or to remove psychological effects of androgens without changing make identity; in these cases, the criteria for gender dysphoria are not met.

 

Resources

  • American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders. (5th ed.) Arlington, VA: American Psychiatric Association.
  • American Psychiatric Association. (2019). Retrieved from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.
  • Child Mind Institute. (2019). Retrieved from: https://childmind.org/guide/guide-to-gender-dysphoria/#gender-dysphoria-what-is-it
  • Psychology Today. (2019). Retrieved from: https://www.psychologytoday.com/us/conditions/gender-dysphoria
  • WebMD. (2019). When You Don’t Feel at Home With Your Gender. Retrieved from: https://www.webmd.com/sex/gender-dysphoria#2-2