What is Gender Dysphoria?

What is Gender Dysphoria

By: Peter Buggert | Last Reviewed: 10/12/19 Last Updated: 10/12/19

What is gender dysphoria? The answer to that question depends on if we are talking about the medical definition or the informal definition. While by the medical definition gender dysphoria is a medical condition with set diagnostic criteria, the informal definition is more about a feeling commonly felt by transgender people.

Before talking about gender dysphoria we should first talk about dysphoria. If we think of euphoria as a feeling of profound happiness, then dysphoria is its opposite. Dysphoria is a profound feeling of discomfort, distress, unease, or dissatisfaction with life commonly causing a person to feel unhappy or unwell. Dysphoria can be accompanied by a feeling of disconnect from the physical world and one’s body, like one’s consciousness is one entity but their body and the world is another. When people say thing like “I was going through the motions but not really living life” there is a good chance that they are talking about dysphoria. While dysphoria is not a mental illness in itself, it is a symptom of many mental illnesses like depression.

Dysphoria can also be a mood or a feeling that lasts for a while and then goes away on its own. Most typically in people that don’t suffer from mental illness this would be brought on by stress or grief. If a person feels dysphoria for an extended period of time they should seek professional help as dysphoria is linked to suicide.

Gender dysphoria shares many of the symptoms of dysphoria, just with a more narrow scope. Much like dysphoria, gender dysphoria is a feeling of unease, distress, discomfort, or dissatisfaction, but aimed at one’s sex assigned at birth. This feeling is usually brought on because a person’s sex assigned at birth and their internal sense of gender do not match, even if this is unknown to the individual.

Gender dysphoria is currently considered a medical condition that may require treatment, but it is not considered a mental illness which is the topic of many debates.

Looking further into Gender Dysphoria as a medical condition, an article by the American Psychiatric Association summarized the symptoms of Gender Dysphoria best when it stated:

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

In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:

  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

In children, gender dysphoria diagnosis involves at least six of the following and an associated significant distress or impairment in function, lasting at least six months.

  1. A strong desire to be of the other gender or an insistence that one is the other gender
  2. A strong preference for wearing clothes typical of the opposite gender
  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. A strong rejection of toys, games and activities typical of one’s assigned gender
  7. A strong dislike of one’s sexual anatomy
  8. A strong desire for the physical sex characteristics that match one’s experienced gender

For children, cross-gender behaviors may start between ages 2 and 4, the same age at which most typically developing children begin showing gendered behaviors and interests. Gender atypical behavior is common among young children and may be part of normal development. Children who meet the criteria for gender dysphoria may or may not continue to experience it into adolescence and adulthood. Some research shows that children who had more intense symptoms and distress, who were more persistent, insistent and consistent in their cross-gender statements and behaviors, and who used more declarative statements (“I am a boy (or girl)” rather than “I want to be a boy (or girl)”) were more likely to become transgender adults” (American Psychiatric Association).

Informally, gender dysphoria is more commonly referred to as “a feeling of disconnect from one’s sex assigned at birth”. Misinformation about gender dysphoria is very common especially on the internet. Only take information about gender dysphoria from reliable sources.

Experiencing gender dysphoria is not the same as being transgender. There are many other mental illnesses or circumstances that may cause someone to fulfill the diagnostic criteria of gender dysphoria or feel what could be described as gender dysphoria without being transgender. A victim of sexual assault may feel distress surrounding their sex and may try to appear as the opposite sex in order to feel safe, women with eating disorders may desire to have a male physique because males lack the extra fat distribution of females. These people are probably not transgender, just have complex symptoms of a mental illness. Although it is possible for a person to be a victim of assault or have an eating disorder and still be transgender.

History

The recognition of gender dysphoria has changed a lot over time. Instances of people experiencing feelings that fit the description of gender dysphoria have been recorded throughout history, a stories of people being born one gender only to feel they are another have been recorded in ancient civilizations. There are legends from ancient greece of a woman who hated being woman until the gods made her into a man and he fell in love with a beautiful maiden.

Historically there are accounts of transgender people going back as far as 4500 years, with scatterings of their stories of gender dysphoria sprinkled in. In the middle ages a renowned Jewish Philosopher Kalonymus ben Kalonymus born 1286 wrote a poem in his work Even Bohan where they expressed that they despised being a man and called their penis a defect, they strongly desired to be a woman. While it is impossible to know if the poem was satire or is possibly Kalonymus dealing with feelings of homosexuality many take the poem as an early account of gender dysphoria.

Multiple cultures recognize more than two genders although all of them serve a different purpose. Many of these genders are for people with intersex conditions although some are for people who feel they have been born with the spirit of one gender and the body of another. The way that these cultures treated these people varies greatly, some were treated as gods and others as outcasts on the lowest tier of society.

Gender dysphoria first appeared in the DSM-III in 1980 under the name Gender Identity Disorder, then under the same name in the DSM-IV in 1994. It was given the name gender dysphoria in the DSM-V which came out in 2013.

Before the DSM-III the word transgender did not exist, there was only transsexual which was seen as a form of extreme homosexuality. Homosexuality was removed from the DSM-II in the 70’s. Gender Identity Disorder was categorized under “Disorders Usually First Evident in Infancy, Childhood or Adolescence” and only included youths in its criteria completely ignoring adults. It had three categories under its reach “GID/Children Transsexualism”; “GID/Adolescent and Adult, Non-transsexual type” and “GID/Not Otherwise Specified”. At this point most health professionals believed therapy to be the best cure for gender identity disorder.

With the DSM-IV some changes were made mostly in to the type of language used. The word transsexual was replaced with Gender Identity Disorder in Adolescents and Adults. The categories were renamed as “Gender Identity Disorder in Children”, “Gender Identity Disorder in Adolescents or Adults”, and “Gender Identity Disorder Not Otherwise Specified”. Understanding of transgender people has slowly begun to increase. Surgeries have slowly becoming more available and transition is starting to be seen as a more valid option due to the the transgender rights movement, but therapy is still a common practice.

The DSM-V and their definition of gender dysphoria changed the way that we look at transgender people in the health industry. No longer was being transgender seen as a disorder or a type of homosexuality, but a condition one is born with that can be discovered at any age. The categories were split into only two separate criteria, one for children and one for adults with no mentions of transsexualism, transgenderism, or non transgenderism. It simply exists on its own.

Future

Nobody is certain on what the future of gender dysphoria holds. Some believe it should be eliminated altogether as being transgender is not a mental illness or condition. Others say it needs to stay because the distress felt by transgender people living as their assigned sex is very real and needs to be taken seriously and treated. Without gender dysphoria as a recognized medical condition insurances and public health programs no longer have a reason to cover transgender surgeries or hormones because it is not treating a condition.

Gender Euphoria

Gender euphoria is an informal term used to describe what would be the opposite of gender dysphoria, a feeling of profound happiness and belonging felt towards one’s gender identity. It could be said that the feeling of a stranger calling a trans person the correct pronouns would a feeling of gender euphoria. Unlike gender dysphoria, gender euphoria is a term invented by the trans community and does not have a proper medical definition or recognition.

Debate

There is a lot of debate in the transgender community over gender dysphoria and how it relates to being trans. Some trans people believe that a medical diagnosis of gender dysphoria is required for being transgender, some people believe that just the informal feeling of gender dysphoria is required, and some believe that no gender dysphoria at all is required to be transgender and that you can be perfectly happy as your sex and still be transgender.

Gender euphoria is often brought up in these debates. For instance if someone is happy with their sex at birth, but feels extreme happiness when they think of living as a different gender, does that make them transgender? Some people believe yes, but others are not convinced for various reasons. Some people argue that under the bases of just requiring gender euphoria to be transgender then people who cross dress as a fetish would technically be considered transgender.

There is no real way to settle this debate as it is an opinion on a complex issue that there remains little data about. It is mostly an issue of language and how we label and define transgender as a society. Further studies into what makes people transgender could provide some insight, but it is unlikely there will ever be a real answer.


Sources and Resources for more Information about Gender Dysphoria

American Psychiatric Association (APA). (n.d.). What is Gender Dysphoria. Retrieved July 15, 2019, from https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

  • This webpage by the American Psychological Association (the largest psychology focused organization in the world) talks about gender dysphoria, its symptoms, treatment, and challenges. Other articles offered by the APA include a Q and A about Gender Dysphoria and patient stories.

American Psychiatric Association (APA). (2015, January). The DSM-5 Diagnostic Criteria for Gender Dysphoria. Retrieved July 15, 2019, from https://www.researchgate.net/publication/296700032_The_DSM-5_Diagnostic_Criteria_for_Gender_Dysphoria

  • A PDF of the chapter of the DSM-5 where gender dysphoria is discussed.

Koh, J. (2012). The history of the concept of gender identity disorder. Retrieved July 15, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/22844818

  • This paper talks about the history of gender dysphoria and how it has been viewed and diagnosed in the medical field.

National Health Service (NHS). (n.d.). Gender Dysphoria. Retrieved July 15, 2019, from https://www.nhs.uk/conditions/gender-dysphoria/

  • The National Health Service (NHS) is the government-funded organization that funds medical care for the people of the UK including England, Scotland, Wales, and Ireland. In this web page, they give an overview of gender dysphoria, its symptoms, treatment, and guidelines for medical professionals.

Wikipedia. (2019, July 11). Gender Dysphoria. Retrieved July 15, 2019, from https://en.wikipedia.org/wiki/Gender_dysphoria

  • Wikipedia is a website that is edited and maintained by its users, so any information taken from the website should be verified. The article talks about gender dysphoria, its symptoms, epidemiology, history, causes, diagnosis, relation to society, and suggests further readings.

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