From the Guidelines
The DSM-5 defines gender dysphoria as a marked incongruence between one's experienced/expressed gender and assigned gender, lasting at least six months, as manifested by at least two specific criteria, and this condition must be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. According to the most recent evidence, the diagnosis of gender dysphoria is a complex issue, and it is essential to understand the current terminology pertaining to transgender and gender-diverse (TGD) medicine 1. The term "gender dysphoria" is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but expressions of gender identity are not a mental health condition per se 1.
Key Considerations
- The experience of gender dysphoria is distinct from the capitalized Gender Dysphoria, which is a controversial diagnosis in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders 1.
- Gender identity and gender expression are separate concepts and are not confined to binary definitions, and they are better viewed on a spectrum that may change over time 1.
- The diagnosis of gender dysphoria helps clinicians identify individuals who may benefit from gender-affirming interventions, which can include psychotherapy, hormone therapy, and/or surgical interventions based on individual needs 1.
- Treatment approaches are typically individualized and may involve a multidisciplinary team including mental health professionals, endocrinologists, and surgeons 1.
Implications for Practice
- Affirming a person's gender identity and expression, or exploration of such, is associated with many positive outcomes related to health, well-being, and quality of life 1.
- Research has shown that TGD persons in an affirming environment experience less psychological distress and suicidal ideation, important factors to strive for when treating pain 1.
- The next edition of the International Classification of Diseases (ICD) will discard the term gender dysphoria and replace it with the term gender incongruence in a new chapter on sexual health 1.
From the Research
DSM V Criteria for Gender Dysphoria
The DSM V criteria for gender dysphoria include:
- A marked incongruence between one's experienced/expressed gender and assigned gender, as evidenced by at least two of the following:
- A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics
- A strong desire to be rid of one's primary and/or secondary sex characteristics
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of the other gender
- The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning 2.
Diagnosis and Treatment
Diagnosis of gender dysphoria is typically made by a qualified healthcare professional, such as a psychologist or psychiatrist, using a comprehensive diagnostic evaluation. Treatment for gender dysphoria may include:
- Hormone therapy to suppress the development of secondary sex characteristics or to induce the development of secondary sex characteristics of the desired gender
- Surgery to alter primary and/or secondary sex characteristics
- Psychotherapy to address any underlying mental health concerns or to support the individual in their transition
- Social support and counseling to help the individual navigate the transition process and address any related issues 3, 4, 5.
Mental Health and Psychosocial Functioning
Research suggests that individuals with gender dysphoria may experience elevated rates of depression, anxiety, and difficulties with peer relationships. A study of adolescents seeking gender-affirming hormone therapy found that approximately half of participants reported clinically significant difficulties with internalizing symptoms and psychosocial functioning, with approximately one-third indicating significant difficulties with depression, anxiety, obsessive compulsive, and posttraumatic stress symptoms 6.
Key Considerations
Key considerations in the diagnosis and treatment of gender dysphoria include:
- A comprehensive diagnostic evaluation to determine the presence and severity of gender dysphoria
- A treatment plan that is individualized to the needs and goals of the individual
- Ongoing monitoring and support to address any related mental health concerns or issues that may arise during the transition process
- Collaboration with qualified healthcare professionals, such as psychologists, psychiatrists, and endocrinologists, to ensure comprehensive care 2, 3, 4, 5.