Gender dysphoria (formerly known as gender identity disorder in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders, or DSM) is defined by strong, persistent feelings of identification with another gender and discomfort with one's own assigned gender and sex; in order to qualify for a diagnosis of gender dysphoria, these feelings must cause significant distress or impairment. People with gender dysphoria often desire to live in accordance with their gender identity and may dress and use mannerisms associated with the gender with which they identify in order to achieve this goal.
Both gender identity issues and feelings of dysphoria may manifest in a variety of different ways. A person with female sex characteristics, for example, may privately identify as a man, but continue to publicly present themselves as a woman. Another may choose to dress in clothes associated with the gender with which they identify, while yet another may seek hormone treatment or surgery as part of a transition to living full-time as the gender with which they identify. Each of these individuals may—or may not—experience significant feelings of distress or impairment as a result of their gender identity concerns. Adults with gender dysphoria typically feel uncomfortable being regarded by others as their assigned gender and often desire to be rid of the physical sex characteristics associated with it
Gender identity incongruence and the feelings of distress that indicate gender dysphoria can be present in children, adolescents, or adults, and can manifest differently across age groups. A child who is assigned one gender may express the wish to be a different gender, state that they are, or assert that they will grow up to be. They may also prefer the clothing, hairstyles, or toys typically associated with the other gender and may demonstrate intense negative reactions when adults in their life attempt to have them wear clothing associated with their assigned gender. Additionally, some children will show discomfort with their physical sex characteristics.
Gender dysphoria in adults and children is considered a disorder if the person also experiences significant distress or impairment in major areas of life as a result of the incongruence. Identifying with a gender different from the one that was assigned is no longer considered a mental disorder in itself.
Associated Features and Disorders of Gender Dysphoria
Due to feelings of distress and stigma, many individuals with gender dysphoria become socially isolated—whether by choice or through ostracism—which can contribute to low self-esteem and may lead to school aversion or even dropping out.
In some cases of gender dysphoria, the disturbance can be so pervasive that an individual’s mental life revolves around activities that lessen gender-related distress. These individuals may be preoccupied with their appearance, especially prior to or early in a formal gender transition. Relationships with family members may also be seriously impaired, particularly in cases where family members hold negative or stigmatizing views about transgender or gender non-conforming individuals.
Suicidal ideation, suicide attempts, and substance-related disorders are relatively common among those experiencing gender dysphoria. After gender transition occurs, suicide risk may dissipate or persist, depending on the adjustment of the individual. Children with gender dysphoria may manifest coexisting separation anxiety disorder, generalized anxiety disorder, or symptoms of depression. Adults may display anxiety and depressive symptoms as well.
Gender dysphoria has been reported across many countries and cultures, and incongruences between sex and gender have existed in human society for thousands of years. According to the DSM-5, among individuals who are assigned male at birth, approximately 0.005 percent to 0.014 percent are later diagnosed with gender dysphoria. Among individuals who are assigned female at birth, approximately 0.002 percent to 0.003 percent are later diagnosed with gender dysphoria. Because these estimates are based on the number of people who seek formal treatment—including hormone therapy and/or surgical reassignment—these rates are likely an underestimate of actual prevalence.
The level of distress experienced by someone with gender dysphoria is significant, and individuals do much better if they are in supportive environments, allowed to express their gender in the way that’s most comfortable to them, and are given knowledge that, if necessary, treatments exist to reduce the sense of incongruence they feel.