Gender dysphoria: definition, diagnosis, treatment and challenges


This is Bob. Bob is biologically defined as a male, which
is a gender that has been assigned to him. But, growing up, Bob realizes that he does
not feel comfortable being recognized as a male
in society. Also, he doesn’t feel comfortable with his
body and the gender roles which are assigned to him. After consulting with a psychiatrist, he recognized
that he is living with a condition called Gender Dysphoria. Let’s learn more about this condition. Gender dysphoria (which has its own chapter
in the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders, termed DSM5) involves a conflict between people’s physical or
assigned gender and the gender with which they identify. Let’s first clarify what the terms
gender, assigned gender, and gender dysphoria are. Gender denotes the public and usually legally
recognized lived role. Biological factors combined
with social and psychological factors contribute to gender development. Assigned gender refers to a person’s initial
assignment as male or female at birth. It is based on
anatomy and other visible physical sex characteristics. Gender dysphoria is a term which refers
to an individual’s discontentment with their assigned gender. People with gender dysphoria may be very uncomfortable
with the gender they were assigned, sometimes described as being uncomfortable
with their body or with the expected roles of their
assigned gender. This gender conflict affects people in different
ways. It can change the way a person wants to
express their gender through behavior, choice of dress, and self-image. Some people may
cross-dress, some may want to socially transition, while others may want to medically transition
with sex-change surgery and/or hormone treatment. If a psychiatrist determines that the patient
has at least 2 of the following characteristics for at
least six months, they can diagnose the patient with gender dysphoria:
1. A marked incongruence between one’s experienced/expressed
gender and primary and/or secondary sex characteristics
2. A strong desire to be rid of one’s primary
and/or 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 of the other gender
5. A strong desire to be treated as the other
gender 6. A strong conviction that one has the typical
feelings and reactions of the other gender Treatment options for gender dysphoria include
counseling, cross-sex hormones, puberty suppression, and gender reassignment surgery. For many children the feelings do not continue
into adolescence and adulthood. While some
children express feelings and behaviors relating to gender dysphoria at 4 years old or younger,
many may not express feelings and behaviors until puberty or much later. But, in general, a
child’s treatment typically involves a multidisciplinary team of health care professionals, which
may include a pediatrician, a psychiatrist, a pediatric endocrinologist who specializes
in hormone conditions in children, and an advocate. Treatment may focus primarily on affirming
psychological support, understanding feelings and coping with distress, and giving children
a safe space to articulate their feelings. It is important to note that Gender dysphoria
is not the same as gender nonconformity. Gender
nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is
the presence of clinically significant distress
associated with the condition. The Sexual and Gender Identity Disorders Work
Group was concerned that removing gender dysphoria as a psychiatric diagnosis from
the DSM5 would jeopardize access to care. Replacing
the condition’s former name of gender “disorder” with “dysphoria” in the diagnostic label
is more appropriate with clinical sexology terminology
and it also removes the connotation that someone is “disordered.” Ultimately, the changes regarding gender dysphoria
in the DSM-5 respect the individuals identified by offering
a diagnostic name that is more appropriate to the
symptoms and behaviors they experience without jeopardizing their access to effective treatment
options. WIth all these support groups and the available
treatment options present, Bob can finally feel
content about his emotions and thought processes and live life how he deserves.