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Gender dysphoria

Gender identity disorder, as identified by psychologists and medical doctors, is a condition with which a person who has been assigned one gender (usually at birth on the basis of their sex, but compare intersexual), but identifies as belonging to another gender, or does not conform with the gender role their respective society prescribes to them. It is a psychiatric term for what is widely known by terms like transsexuality, transgender and (subject to debate, but full-fledged GID is present in at least some cases) transvestism or cross-dressing. Another proposed term for the condition is Benjamin’s Syndrome, named for Harry Benjamin, a pioneering researcher in the field of transsexuality.

This feeling is usually reported as “having always been there”, although in some cases, it seems to appear in adolescence or even in adulthood, and it has been reported by some as intensifying over time. Since many cultures strongly disapprove of cross-gender behaviour, it often results in significant problems for those affected, and sometimes for their close friends and family members as well. In many cases, discomfort is also reported as stemming from the feeling that one’s body is “wrong” or meant to be different.

Diagnostic criteria

DSM-IV

The current edition of the Diagnostic and Statistical Manual of Mental Disorders has five criteria that must be met before a diagnosis of Gender Identity Disorder (302.85) can be given: [1]

  1. There must be evidence of a strong and persistent cross-gender identification.
  2. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.
  3. There must also be evidence of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex.
  4. The individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia).
  5. There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The DSM-IV also provides a code for gender disorders that did not fall into these criteria. This diagnosis of Gender Identity Disorder Not Otherwise Specified (GIDNOS, 302.6) is similar to other “NOS” diagnoses, and can be given for, for example: [2]

  1. Intersex conditions (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
  2. Transient, stress-related cross-dressing behavior
  3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex, which is known as skoptic syndrome

For some people, GID in the DSM-IV is comparable to transsexuality, whereas GIDNOS, to them, is more comparable to other transgender conditions that may be seen as disorderly. On the other hand, many transgender people themselves feel quite accurately described by the DSM-IV, and many have none of the symptoms listed above under NOS. Some transsexual and transgender people do not feel like the DSM-IV describes their condition accurately, in any sense.
Transvestic fetishism has its own code, as a paraphilia rather than a gender identity disorder.

ICD-10

The current edition of the International Statistical Classification of Diseases and Related Health Problems has five different diagnoses for gender identity disorder: transsexualism, Dual-role Transvestism, Gender Identity Disorder of Childhood, Other Gender Identity Disorders, and Gender Identity Disorder, Unspecified. [3]

Transsexualism has the following criteria:

  • The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment.
  • The transsexual identity has been present persistently for at least two years.
  • The disorder is not a symptom of another mental disorder or a chromosomal abnormality.

Dual-role transvestism has the following criteria:

  • The individual wears clothes of the opposite sex in order to experience temporary membership in the opposite sex.
  • There is no sexual motivation for the cross-dressing.
  • The individual has no desire for a permanent change to the opposite sex.

Gender Identity Disorder of Childhood has essentially four criteria, which may be summarised as:

  • The individual is persistently and intensely distressed about being a girl/boy, and desires (or claims) to be of the opposite gender.
  • The individual is preoccupied with the clothing, roles or anatomy of the opposite sex/gender, or rejects the clothing, roles, or anatomy of his/her birth sex/gender.
  • The individual has not yet reached puberty.
  • The disorder must have been present for at least 6 months.

The remaining two classifications have no specific criteria and may be used as “catch-all” classifications in a similar way to GIDNOS.

Since, very often, many people (including doctors, judges etc.) assume that the classifications “transsexual” and “transvestite” can apply only to adults, the F64 section of the ICD-10 is often criticised, especially since the “usually” in “usually accompanied by the wish to make his or her body as congruent as possible ” is often ignored as well, and wish for sexual reassignment surgery (SRS) is seen as a requirement for the diagnosis of “transsexualism”. However, an increasing number of physicians and therapists are treating transsexual people who have no desire for surgery, sometimes known as “non-op” transsexuals.

Many transgender people, however, do not fit into either of these two categories; for example, transgender people who wish to change their social gender completely, but who do not bother with SRS. This can lead to significant problems with things such as procuring medical treatment and legal change of name and/or gender; in some cases, it may make them completely impossible.

Controversy

A lot of transgender people do not regard their cross-gender feelings and behaviours as a disorder. They question what a “normal” gender identity or a “normal” gender role is supposed to be. Sometimes, even the very existence of a “normal” gender identity or gender role is examined, and often rejected by sectors of modern gender studies. They often point out that not everyone who is born male is stereotypically masculine, and not everyone born female is stereotypically feminine.

Some people see “transgendering” as a means for deconstructing gender. However, not all transgender people wish to or feel that they are deconstructing gender.

Other transgender people object to the classification of GID as a mental disorder on the grounds that there may be a physical cause, as suggested by recent studies about the brains of transsexual people. Many of them also point out that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one’s perception of mental (psychological, emotional) gender identity, rather than vice versa.

Even though the preponderance of evidence suggests that transgender behaviour has a neurological etiology, clear and convincing evidence has yet to show whether the etiology of transgender is mental or physical. Thus the psychiatric diagnoses will continue to carry authority, and remain useful for medical billing purposes and potentially for the classification of research results, unless those diagnoses are debunked. However, little or no research into transgenderism or transsexualism is actually being conducted, especially in North America. The mental illness diagnoses are also enshrined in the HBIGDA-SOCs; they persist because no other medical diagnoses are available.

However, it should be noted that there are numerous diagnoses included in the DSM for which there is strong evidence of a genetic and neurobiological etiology such as schizophrenia, autism, and bipolar disorder. Dividing conditions into ‘biological’ versus ‘psychological’ is not a scientifically supported dichotomy. Therefore, the medical community recognizes that psychiatric illnesses often have their origins in disorders of chemistry, not of character. Psychiatric conditions are not separate from biological disorders, but rather a subset of biological disorders.

In a landmark publication in December 2002, the British Lord Chancellor’s office published a Government Policy Concerning Transsexual People document that categorically states “What transsexualism is not…It is not a mental illness.” It would appear to be likely that other countries will follow this lead. Nonetheless, existing psychiatric diagnoses of gender identity disorder or the now obsolete categories of homosexual disorder, gender dysphoria syndrome, true transsexual, etc., continue to be accepted as formal evidence of transsexuality.

The official politics in many countries interpret transgenderism as an undesirable behavior that must be prohibited, or as a psychiatric disorder, which should be cured. See Heteronormativity

Treatment

Medicine and psychology have tried to cure gender identity disorder and transgender behaviour/feelings ever since they came to their attention in the mid-19th century. Only occasionally have reports of “cures” been found, and almost all of them lack a follow-up. Also, almost all of those reports can be matched with the stories of transgender people who at one point left a treatment as cured. (Some transgender people were in fact “cured” several times.) It was demonstrated that psychological cures were almost completely ineffective, unless the reason for transgender behaviour could clearly be identified as laying outside of the person showing this behaviour.

Medical treatment for changing a person’s sexual characteristics (see Gender reassignment therapy) is not considered a cure for transsexual or transgender feeling or behaviour, but it can help transsexual persons to live in a gender role that is more appropriate for their gender identity. But, while there will likely always be transgender people who will need this kind of medical treatment, many believe that the best help for transgender people is social acceptance in a gender role that fits their identity, regardless of their individual perception of their appropriate gender role or their individual need for medical treatment.

See Also

  • List of transgender-related topics

External links