Gender dysphoria: Difference between revisions

Alternate or similar terms include “gender identity disorder” (which was opposed by activists for characterizing the experience as a mental disorder) and “gender incongruence” <ref>{{Cite web |title=WHO: Revision of ICD-11 (gender incongruence/transgender) – questions and answers (Q&A) |author=World Health Organization (WHO) |work=YouTube |date=18 June 2018 |access-date=13 May 2020 |url= https://www.youtube.com/watch?v=kyCgz0z05Ik|archive-url=https://web.archive.org/web/20230604184343/https://www.youtube.com/watch?v=kyCgz0z05Ik |archive-date=17 July 2023 }}</ref>. The opposite of gender dysphoria is [[gender euphoria]], which refers to positive feelings that come out of a part of gender experience or expression. People may experience gender euphoria without experiencing gender dysphoria.

Research on gender dysphoria was historically rare-to-nonexistent, but an increasing number of researchers are taking interest.<blockquote>The exact cause of gender dysphoria is unknown. It is currently classed as a psychiatric condition (relating to the mind), but many recent studies have suggested that it is more to do with biological development (relating to the body). Research into what causes gender dysphoria is ongoing. <ref name=":1">http://www.nhs.uk/conditions/gender-dysphoria/pages/introduction.aspx [https://web.archive.org/web/20230526090651/http://www.nhs.uk/conditions/Gender-dysphoria/Pages/Introduction.aspx Archived] on 17 July 2023</ref></blockquote>

Studies on the frequency of gender dysphoria are typically skewed toward people who seek particular medical treatments, leaving out the wide variety of those who do not seek medical attention.  Actual rates of occurrence in the general population are likely much higher, by a still-unknown amount. <ref>https://cpa.ca/docs/File/Publications/FactSheets/PsychologyWorksFactSheet_GenderDysphoriaInAdolescentsAndAdults.pdf [https://web.archive.org/web/20230602043645/https://cpa.ca/docs/File/Publications/FactSheets/PsychologyWorksFactSheet_GenderDysphoriaInAdolescentsAndAdults.pdf Archived] on 17 July 2023</ref>

A 2017 study in the USA shows:<blockquote>In childhood, the sex ratio continues to favour birth-assigned males, but in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females. In both adolescents and adults, patterns of sexual orientation vary as a function of birth-assigned sex. Recent studies suggest that the prevalence of a self-reported transgender identity in children, adolescents and adults ranges from 0.5 to 1.3%, markedly higher than prevalence rates based on clinic-referred samples of adults. The stability of a self-reported transgender identity or a gender identity that departs from the traditional male-female binary among non-clinic-based populations remains unknown and requires further study. <ref>https://www.ncbi.nlm.nih.gov/pubmed/28838353 [https://web.archive.org/web/20230528115122/https://www.ncbi.nlm.nih.gov/pubmed/28838353 Archived] on 17 July 2023</ref></blockquote>A retrospective study of patients seen from 1972 to 2015 at a Netherlands clinic shows:<blockquote>During that time, 6,793 people sought help at the center. About 65% were transwomen, and 35% were transmen. The researchers noted a 20-fold increase over time, with 34 gender dysphoria assessments in 1980 and 686 in 2015.</blockquote><blockquote>As of the end of 2015, 3,838 people age 16 and over and received treatment for gender dysphoria at the center. Using the over-16 population of the Netherlands as a guide, the researchers estimated that 1 in 3,600 people in that country were transgender, with 1 in 2,800 identified as transwomen and 1 in 5,200 identified as transmen. <ref>https://www.issm.info/news/sex-health-headlines/study-examines-prevalence-of-gender-dysphoria-in-the-netherlands/ [https://web.archive.org/web/20210729085425/https://www.issm.info/news/sex-health-headlines/study-examines-prevalence-of-gender-dysphoria-in-the-netherlands/ Archived] on 17 July 2023</ref></blockquote>

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013.  Prior to its release, the APA published a [http://www.dsm5.org/Documents/Gender%20Dysphoria%20Fact%20Sheet.pdf 'Gender Dysphoria Fact Sheet'] on their website which states,<blockquote>In the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people whose gender at birth is contrary to the one they identify with will be diagnosed with gender dysphoria. This diagnosis is a revision of DSM-IV’s criteria for gender identity disorder and is intended to better characterize the experiences of affected children, adolescents, and adults...</blockquote><blockquote>DSM not only determines how mental disorders are defined and diagnosed, it also impacts how people see themselves and how we see each other. While diagnostic terms facilitate clinical care and access to insurance coverage that supports mental health, these terms can also have a stigmatizing effect...</blockquote><blockquote>DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name “gender identity disorder” with “gender dysphoria,” as well as makes other important clarifications in the criteria. It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition...</blockquote><blockquote>Part of removing stigma is about choosing the right words. Replacing “disorder” with “dysphoria” in the diagnostic label is not only more appropriate and consistent with familiar clinical sexology terminology, it also removes the connotation that the patient is “disordered”. <ref>http://www.dsm5.org/about/Pages/DSMVOverview.aspx [https://web.archive.org/web/20230415163357/http://www.dsm5.org/about/Pages/DSMVOverview.aspx Archived] on 17 July 2023</ref></blockquote>

In the GID Reform Weblog, [[Kelley Winters]], Ph.D., describes her critiques of the revised standards in the DSM-5:<blockquote>The new revisions for the Gender Dysphoria diagnosis in the DSM-5 are mostly positive. However they do not go nearly far enough. The change in title from Gender Identity Disorder (intended by its authors to mean “disordered” gender identity) to Gender Dysphoria (from a Greek root for distress) is a significant step forward. It represents a historic shift from gender identities that differ from birth assignment to distress with gender assignment and associated sex characteristics as the focus of the problem to be treated...</blockquote><blockquote>In another positive change, the Gender Dysphoria category has been moved from the Sexual Disorders chapter of the DSM to a new chapter of its own. Non-binary queer-spectrum identities and expression are now acknowledged in the diagnostic criteria...</blockquote><blockquote>However, the fundamental problem remains that the need for medical transition treatment is still classed as a mental disorder. In the diagnostic criteria, desire for transition care is itself cast as symptomatic of mental illness, unfortunately reinforcing gender-reparative psychotherapies which suppress expression of this “desire” into the closet. The diagnostic criteria still contradict transition and still describe transition itself as symptomatic of mental illness. The criteria for children retain much of the archaic sexist language of the DSM-IV-TR that psychopathologizes gender nonconformity. Moreover, children who have happily socially transitioned are maligned by misgendering language in the new diagnosis.</blockquote><blockquote>More troubling is false-positive diagnosis for those who have happily completed transition. Thus, the GD diagnosis, and its controversial post-transition specifier, continue to contradict the proven efficacy of medical transition treatments.  This contradiction may be used to support gender conversion/reparative psychotherapies – practices described as no longer ethical in the current WPATH Standards of Care. <ref>http://gidreform.wordpress.com/2013/06/13/gid-reform-in-the-dsm-5-and-icd-11-a-status-update/ [https://web.archive.org/web/20230602043535/http://gidreform.wordpress.com/2013/06/13/gid-reform-in-the-dsm-5-and-icd-11-a-status-update/ Archived] on 17 July 2023</ref></blockquote>

Announced in June 2018, the new International Classification for Diseases (ICD-11) will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022.<ref>https://www.who.int/news-room/detail/18-06-2018-who-releases-new-international-classification-of-diseases-(icd-11) [https://web.archive.org/web/20230424035913/https://www.who.int/news-room/detail/18-06-2018-who-releases-new-international-classification-of-diseases-%28icd-11%29 Archived] on 17 July 2023</ref>  The WHO explains the reasoning behind their changes for trans health:<blockquote>Gender incongruence, meanwhile, has also been moved out of mental disorders in the ICD, into sexual health conditions. The rationale being that while evidence is now clear that it is not a mental disorder, and indeed classifying it in this can cause enormous stigma for people who are transgender, there remain significant health care needs that can best be met if the condition is coded under the ICD. <ref>https://www.who.int/health-topics/international-classification-of-diseases [https://web.archive.org/web/20230701122407/https://www.who.int/health-topics/international-classification-of-diseases Archived] on 17 July 2023</ref></blockquote>

At present, WPATH asserts that "knowledge of the factors contributing to gender identity development in adolescence is still evolving and not yet fully understood by scientists, clinicians, community members, and other stakeholders in equal measure." <ref name=":0">https://www.transadvocate.com/wpath-responds-to-rapid-onset-gender-dysphoria-rogd_n_24661.htm [https://web.archive.org/web/20230210184734/https://www.transadvocate.com/wpath-responds-to-rapid-onset-gender-dysphoria-rogd_n_24661.htm Archived] on 17 July 2023</ref>  The ways in which gender dysphoria affects teenagers and adults differs to the way that it affects children; this is primarily due to the pubertal development of the body and the influence of sexual desire on social relationships. These feelings can often be very difficult to deal with and, as a result, a high percentage of gender dysphoric individuals experience depression, and may feel isolated from their peers; there are high rates of self-abusive behaviours and suicide within the gender dysphoric demographic.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914494/ [https://web.archive.org/web/20230611144421/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914494 Archived] on 17 July 2023</ref> Finding a way to interpret and communicate these feelings as a nonbinary individual, at any age, can be profoundly distressing due to the lack of nonbinary reference points within the dominant culture, even more-so when ones nonbinary identity is dismissed by others on that same basis.