Strong, ongoing feelings of identification with different gender and dissatisfaction with one’s assigned gender and sex are symptoms of gender dysphoria, previously known as gender identity disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM. These feelings must significantly distress or impair a person to be diagnosed with gender dysphoria. People with gender dysphoria often want to live according to their gender identity, and they may dress and act in ways that are typical of the gender they identify with.

Associated Features and Disorders of Gender Dysphoria

Many people with gender dysphoria withdraw from social situations out of choice or due to ostracism due to feelings of pain and stigma, which may lower self-esteem and increase the likelihood that they will avoid going to school or perhaps drop out.

In certain instances of gender dysphoria, the disorder may be so widespread that a person’s mental life becomes focused on things that help them feel less distressed about their gender. These people could be obsessed with their appearance, particularly before or during a formal gender change. Relationships with family members may also be severely harmed, especially if they have unfavorable or stigmatizing opinions on transgender or gender non-conforming people.

Sadly, drug use problems, suicidal thoughts, and suicide attempts are more prevalent among people with gender dysphoria than in the general population. Depending on how the person adjusts, the risk of suicide may decrease or increase after a gender change. Children with gender dysphoria may also experience generalized anxiety disorder, separation anxiety disorder, or depressive symptoms. Adults might also experience anxiety and depression symptoms.

Incongruities between sex and gender have persisted in human civilization for thousands of years, and gender dysphoria has been documented in many different nations and cultures. An individual with gender dysphoria may experience a high level of distress. Still, they will fare much better if they are in supportive environments, allowed to express their gender in the manners they find most comfortable, and informed that, if necessary, treatments are available to lessen the sense of dissonance they experience.

Symptoms

Various age groups exhibit gender dysphoria in different ways. The following symptoms should be present under the DSM-5 for medical practitioners to determine whether to diagnose gender dysphoria in kids, teenagers, and adults:

Children

• A strong desire to be of the other gender (or another gender identity, such as non-binary) or an insistence that one is of the other gender.
• In boys (assigned gender), a strong preference for wearing or simulating female attire and resistance to wearing traditionally masculine clothing.
• In girls (assigned gender), a strong preference for wearing or simulating feminine attire.

A diagnosis of gender dysphoria may be made if at least six of the symptoms above are present.

• Clinically substantial discomfort or impairment in key areas of functioning, such as interactions with others, learning, or daily activities at home

Adolescents and Adults

• A strong desire to get rid of one’s primary and secondary sex characteristics; a strong desire for the primary and secondary sex characteristics of the other gender; a strong desire to be of the other gender or an alternative gender; a strong desire to be of the other sex; and a strong incongruence between the people experienced/expressed gender and primary sex characteristics (sexual organs) and secondary sex characteristics

If at least two of the symptoms listed above are present, gender dysphoria may be diagnosed if the following criteria are met:

• Clinically substantial discomfort or impairment in key functional domains, such as social interactions, academic performance, or personal responsibilities

Is there debate around the diagnosis of gender dysphoria?

Because being transgender is a social identity rather than a mental disease, the diagnostic of gender dysphoria, in the opinion of some psychologists and activists, ought to be dropped from the DSM. Additionally, the diagnosis mirrors the former categorization of homosexuality as a mental condition.

The International Classification of Diseases, for instance, is a diagnostic guide maintained by the World Health Organization. In place of “gender identity disorder,” the organization’s sexual health section now refers to “gender incongruence” in 2018.

What is rapid-onset gender dysphoria?

Gender dysphoria with rapid onset is not a clinical diagnosis. Professor Lisa Littman of Brown University created the phrase to characterize teenagers who, according to their parents, unexpectedly experienced gender dysphoria due to societal pressure. There is no evidence to support the presence of rapid-onset gender dysphoria, and Littman’s study has received harsh criticism.

Causes

Although the exact reasons for gender dysphoria are unclear at this time, environmental factors, hormonal changes during pregnancy, and genetics are all thought to have a role.

Between 2 and 4 years, cross-gender hobbies and activities often start, and many parents subsequently claim that their kid has always had these interests. In later adolescence or adulthood, only a tiny percentage of children with gender dysphoria will still have symptoms. Children with gender dysphoria are often diagnosed when they start school, especially if peer connections become difficult or parents worry that their child’s gender identity difficulties are more than a phase.

Early to mid-adulthood is often when adult onset occurs. Gender dysphoria can develop in one of two ways:

• The first, which is typically seen in late adolescence or adulthood, is a continuation of gender dysphoria that had an onset in childhood or early adolescence;
• On the other hand, the other course sees the more overt signs of cross-gender identification appear later and more gradually, with a clinical presentation in early to mid-adulthood.

How common is gender dysphoria?

The DSM-5 estimates that between 0.005 percent and 0.014 percent of those born male subsequently get a diagnosis of gender dysphoria. A diagnosis of gender dysphoria is made in around 0.002 percent to 0.003 percent of people born with the gender ascribed to them as female. These percentages are probably understated since they are based on the number of people seeking official treatment, such as hormone therapy and gender confirmation surgery.

When does gender dysphoria develop?

Cross-gender behaviors may start before the age of two, which marks the beginning of the developmental stage in which kids start showing gendered behaviors and interests. Late-onset gender dysphoria, on the other hand, often starts around puberty or much later in life. Early-onset gender dysphoria typically begins in childhood and lasts throughout adolescence and maturity.

Treatment

For children with gender dysphoria, individual and family counseling is advised, but for adults, individual and couple’s treatment is advised. However, not everyone is interested in these alternatives, and feelings of unhappiness could persist even after hormone therapy or gender confirmation surgery. These options ought to be covered in psychotherapy.

While some people can cope with distress symptoms on their own, psychotherapy is often highly beneficial in fostering self-discovery that promotes comfort and coping with intense emotions that may have been brought on by peer pressure or societal stigma. The greatest results for people with gender dysphoria are linked to early identification, a welcoming atmosphere, and thorough therapy that honors the individual’s choices and goals.

How can parents support transgender children or those with gender dysphoria?

Parents with good intentions who want to help their kids may not know how to do it most effectively. Several methods for helping a transgender kid include:

• Accept your child for who they are. (Don’t describe it as a transitory phase.)
• Become knowledgeable about sex, gender, and the distinctions between the two.
• When it comes to their transgender identity, follow your child’s lead. Never assume anything about someone’s behavior, preferences for attire, or preferred name. Being trans doesn’t have a “one way” or a “right way.”
• Keep the fact that your child is trans a secret. Your child should communicate that information.
• Avoid calling your child by their previous name or misgendering them.
• Trans youth may benefit from therapy, but it’s not always accurate to assume that a child needs therapy or other medical attention.