When someone's gender identity or gender expression does not match their biologically assigned sex, their condition is described as gender dysphoria.
The switch from the category of transgender disorder to gender dysphoria disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reveals a deep cultural and scientific change in understanding people of the transgender community. The DSM-5 also separates the diagnosis of gender dysphoria for children from that of adolescents and adults. The characteristics of gender dysphoria vary with age, and many children with gender dysphoria outgrow it as they age.
Thinking about gender used to be binary; there were two genders, male or female. One of the most famous people to change gender was the Welsh journalist, Jan Morris, who changed her gender from a man to a woman through sex reassignment surgery in the 1970s. Current views of transgender identity are now more nuanced than the standard example of transsexualism that was recognized in the past. In fact, people in the transgender community want to be clear that gender identity has nothing to do with sexual orientation. The question for transgender people is who they want to be, not who they want to be with. Changing gender, being gender fluid, or not identifying with either gender has no correlation with whether someone develops bisexual, straight, or gay sexual relationships.
The revision in the DSM-5 suggests that the state of being transgender may not be pathological. Pathology develops from a person's profound unhappiness with their transgender identity in the culture. This radical change is similar to the famous decision in 1973 to eliminate homosexuality from the list of psychiatric disorders. In the new edition of the DSM-5, gender identity disorder (GID) receives a new name, gender dysphoria. These diagnoses define a condition during which a person feels intensely at odds with their biological gender and identifies with, or wants to be, the opposite gender. Some of these people may live as their desired gender; some may seek early medical treatment and use hormones such as Lupron to prevent puberty. By age seven, a child's gender nonconformity is not well-tolerated among others; by adolescence this lack of tolerance becomes severe and the physical changes that ensue are harder to reverse. Some trans people surgically change their faces and their bodies.
According to the DSM-5, to be diagnosed with gender dysphoria, a person has to have symptoms that last for at least six months. For children, these symptoms may include:
For teens and adults, symptoms may include:
Transgender research is fraught with rich and complex debates. The field is evolving with tremendous rapidity. Most specialists in the field concur that standard treatment before sex-change surgery should include the requirement that a transgender person live for a year as that gender before surgery and undergo a year of therapy. At least two clinicians, one an MD, must recommend hormonal treatments. Fundamental concepts of biological determinism, identity, the influence of culture, and the proper use of psychotherapy are all being questioned in this field. Doctors disagree about whether this issue should be treated quickly, before adolescence, or whether it is best to see a person resolve their gender struggle without medical intervention.
The fluidity of gender identity is reflected in academic curriculum, dormitories, and tragically, in suicide attempts. Recent history has shown that cognitive behavioral therapy (CBT), which seeks to shape someone to be a gender, is unsuccessful. Though people may live more conventionally in a gender role after intensive CBT treatment, denying their true identity can result in anxiety, depression, drug use, or suicide. Researchers have found that risk of attempting suicide is severe for transgender or gender-nonconforming people. Suicide attempts are less common among transgender and gender-nonconforming people whose family ties remain strong after they come out. However, being ‘out’ as transgender also appears to be tied to a steeper risk of suicide. People who tell others that they are transgender or gender-nonconforming are more likely to have attempted suicide than those who remain secretive. Researchers believe that being recognized as transgender by others makes a person a target of discrimination and bullying.
See also Child psychology ; Gender constancy ; Gender identity ; Sex differences .
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Giordano, Simona. Children with Gender Identity Disorder: A Clinical, Ethical, and Legal Analysis. New York: Routledge, 2013.
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The Atlantic. “‘Gender Identity Disorder’ to Go the Way of Homosexuality.” http://www.theatlantic.com/health/archive/2012/10/gender-identity-disorder-to-go-the-wayof-homosexuality/264232/ (accessed March 5, 2015).
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National Institutes of Health. “Gender Dysphoria.” http://www.nlm.nih.gov/medlineplus/ency/article/001527.htm (accessed March 5, 2015).