Gender dysphoria occurs when there is a persistent sense of mismatch between one’s experienced gender and assigned gender.
Gender dysphoria (formerly Gender Identity Disorder) is defined by strong, persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex that results in significant distress or impairment. People with gender dysphoria desire to live as members of the opposite sex and often dress and use mannerisms associated with the other gender. For instance, a person identified as a boy may feel and act like a girl.
Identity issues may manifest in a variety of different ways. For example, some people with normal genitals and secondary sex characteristics of one gender privately identify more with the other gender. Some may dress in clothes associated with the gender with which they identify, and some may seek hormone treatment or surgery as part of a transition to living full-time in the experienced gender.
Associated Features and Disorders of Gender Dysphoria
Many individuals with gender dysphoria become socially isolated, whether by choice or through ostracization, which can contribute to low self-esteem and may lead to school aversion or even dropping out. Peer ostracism and teasing are especially common consequences for boys.
Boys with gender dysphoria often show marked feminine mannerisms and speech patterns.
The disturbance can be so pervasive that the mental lives of some individuals revolve only around activities that lessen gender distress. They are often preoccupied with appearance, especially early in the transition to living in the opposite sex role. Relationships with parents also may be seriously impaired. Some males with gender dysphoria resort to self-treatment with hormones and may (very rarely) perform their own castration or penectomy. Especially in urban centers, some males may engage in prostitution, placing them at a high risk for human immunodeficiency virus (HIV) infection. Suicide attempts and substance-related disorders are common.
Children with gender dysphoria may manifest coexisting separation anxiety disorder, generalized anxiety disorder and symptoms of depression.
Adolescents are particularly at risk for depression and suicidal ideation and suicide attempts.
Adults may display anxiety and depressive symptoms. Some adult males have a history of transvestic fetishism as well as other paraphilias. Associated personality disorders are more common among males than among females being evaluated at adult gender clinics.
To be clinically diagnosed with gender dysphoria:
A. Must persistently and strongly identify with the opposite gender (aside from desiring any perceived cultural advantage of being the other gender).
B. A persistent discomfort with his or her sex traits or sense of inappropriateness of the gender associated with those traits. Must have strong discomfort with own gender and may express these qualities:
In adolescents and adults, this is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (such as request for hormones, surgery or other procedures to physically alter sex characteristics) or belief that one was born the wrong sex.
C. Not concurrent with physical intersex condition.
D. Causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
The cause of gender dysphoria is unknown, but hormonal influences in the womb are suspected to be involved. The condition is rare and may occur in children or adults.
There are no recent studies to provide data on prevalence of gender dysphoria. Data from some countries in Europe suggest that roughly 1 per 30,000 adult males and 1 per 100,000 adult females seek sex-reassignment surgery.
Onset of cross-gender interests and activities is usually between ages 2 and 4 years, and some parents report that their child has always had cross-gender interests. Only a very small number of children with gender dysphoria will continue to have symptoms in later adolescence or adulthood. Typically, children are referred around the time of school entry because of parental concern that what they regarded as a phase does not appear to be passing.
Adult onset is typically in early to mid-adulthood, usually after or concurrent with transvestic fetishism. There are two different courses for the development of gender dysphoria:
The later-onset group:
Individual and family counseling is recommended for children, and individual or couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but severe problems may persist after this form of treatment. A better outcome is associated with the early diagnosis and treatment.