From the Guidelines
To diagnose gender dysphoria using the DSM-5, clinicians should focus on the psychological distress associated with the experienced incongruence between gender identity or expression and sex recorded at birth, as defined in the context of gender diverse patients 1. The diagnostic criteria involve a comprehensive assessment of the marked incongruence between one's experienced/expressed gender and assigned gender, which has persisted for at least six months and is accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. Key points to consider in the diagnosis include:
- A strong desire to be of the other gender or insistence that one is the other gender
- A strong desire to be rid of one's primary/secondary sex characteristics or to acquire those of the other gender
- 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
- Gender identity and gender expression are separate concepts and are not confined to binary definitions, but rather viewed on a spectrum that may change over time
- Clinicians should assess for cultural factors that might influence gender expression and identity, as well as co-occurring mental health conditions, and provide affirming care to promote positive outcomes related to health, well-being, and quality of life, as supported by recent research 1. The evaluation should include a detailed clinical interview exploring gender identity development, experiences of gender dysphoria across the lifespan, impact on daily functioning, and any co-occurring mental health conditions, in order to determine appropriate treatment options, which may include psychotherapy, hormone therapy, or surgical interventions based on individual needs and preferences.
From the Research
Diagnostic Criteria for Gender Dysphoria
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the diagnostic criteria for gender dysphoria. According to the studies, the following are the key points to consider:
- Gender dysphoria is characterized by a dissociation between one's expressed gender and the gender of rearing as assigned at birth, which generates significant clinical distress and social, academic, and other important forms of isolation 2.
- The DSM-5 defines gender dysphoria as a condition characterized by mental suffering associated with the incongruence between one's experienced gender and their birth-assigned sex 3.
- The diagnostic name of gender identity disorder was changed to gender dysphoria in the DSM-5, and it refers to 'assigned gender' rather than to 'sex', and includes disorders of sexual development 4.
- The DSM-5 reflects an attempt to include only a medical designation of people who have suffered due to the gender disparity, thereby respecting the concept of transgender in accepting the diversity of the role of gender 4.
Comparison with Other Classification Systems
The studies also compare the DSM-5 with other classification systems, such as the International Classification of Diseases (ICD):
- The ICD-11 has substantially reconceptualized gender identity-related diagnoses and removed them from the mental health chapter, so that the distress criterion is no longer a prerequisite 5.
- The reliability and clinical utility of gender identity-related diagnoses of the ICD-11 were compared with the DSM-5, ICD-10, and DSM-IV, and the results showed that all four systems seem reliable and convenient for clinical use 5.
- The agreement rates for each instrument ranged from 65% to 79% for the adolescence/adulthood diagnoses and from 67% to 94% for the childhood diagnoses, and were comparable regardless of the system used 5.