What Is Gender Dysphoria? DSM 5 And Clinical Symptoms

Reviewed by Laura Angers, LPC

Published 12/14/2020

Gender identity and sexual identity have had a long and varied history. In mental health, both have been alternately recognized as disorders in need of treatment and neurodiversity instances that may require support more than dedicated treatment. Social and political institutions alike continue to debate the complexities of these issues and work to create clear definitions for the sake of treatment, support, and protections. Still, despite decades of work, much of the meaning behind the diagnosis is lost on anyone who is not trained to work with gender and sexual identities. So, what exactly is Gender Dysphoria? A true Gender Dysphoria definition requires a quick look at the history of the condition.

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Gender Dysphoria: A History

The notion of being at odds with biological sex is not a new one. Virtually every culture in history has had some experience with people experiencing these symptoms. In some cultures, these people were revered or considered uniquely set apart, and in others, these people were regarded poorly and were treated inappropriately. Despite the many people who have dealt with Gender Dysphoria over the ages, the condition has enjoyed many different names and treatment methods throughout the years, particularly in the western world. The condition “Gender Dysphoria” was first suggested as an apt description for feeling at odds with one’s biological sex in 1980 and was called “Gender Identity Disorder” in the DSM. Although the 1950s through the 1980s saw increased attention to transsexualism and disparate gender identity, it has only been somewhat recently that these types of mental differences were regarded more like variations of neurological and personality function than disordered symptoms thinking.

Despite the diagnosis of “Gender Dysphoria Disorder” being suggested in the early 1970s, it was not until 2013 that the DSM-V was published. The diagnosis of Gender Identity Disorder was changed to Gender Dysphoria. This name change was quite significant, as it encompassed a wider range of issues involving gender identity disparity and transsexualism, both of which may have been received poorly by mental health professionals up until recently—and, unfortunately, in some mental health facilities today.

What Is Gender Dysphoria? Gender Dysphoria Definition

 Gender Dysphoria is a dysphoric condition that does not fall under the purview of “disorder” due to its symptoms’ unique nature. While mental health disorders as a whole typically focus on an aberration of normal neurological or emotional function, Gender Dysphoria is no longer recognized as a disorder in need of being “fixed,” necessarily, but a legitimate condition in which biology and neurology are at odds. People with Gender Dysphoria can identify as transsexual or may identify in other ways that focus primarily on gender identity rather than sexual identity. This particular disorder was once grouped with other disorders involving sexual identity and sexual orientation. Still, any discussion of sexual orientation is separate from Gender Dysphoria and may not come into play at all during an evaluation for Gender Dysphoria.

DSM Gender Dysphoria: Clinical Symptoms And Diagnosis

Gender Dysphoria is a mental health condition in which an individual experiences distress due to the presence of at least two of the following symptoms:

  • Disparity between sex and gender identity. Biological sex and gender are two different constructs. People with Gender Dysphoria might feel at odds with their biological sex and their perceived gender or may feel primarily at odds with their perceived gender and identify as a gender without a specific assigned biological sex.
  • A strong urge or desire to “get rid of” biological sex characteristics. In this symptom, people with Gender Dysphoria may continually struggle to see their bodies and experience the difficulties associated with dressing for sex they do not feel is theirs. Feelings of repulsion, fear, or shame often accompany this symptom.
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  • A strong urge or desire to possess the biological sex characteristics of the opposite sex. For some, Gender Dysphoria will catalyze a desire to possess the sex characteristics of the opposite sex. For instance, a biological female might not feel entirely at odds with the presence of breasts but may feel a continual longing to possess one or more of the sex organs associated with the male sex.
  • A need or desire to be seen as treated as a specific preferred gender. Again, because sex and gender are two different things, some people with Gender Dysphoria will focus more on their gender than their sex.
  • An ongoing suspicion that you behave as though you are already your preferred gender, despite sex characteristics. For some people with Gender Dysphoria, the experience of being at odds with perceived gender is due to feeling as though their behavior, likes, and thought processes are already congruent with their preferred gender.

It is important to note that not all of these symptoms will be present in someone with a diagnosis of Gender Dysphoria; instead, at least two of them must be present for six months or longer and cause significant distress for a diagnosis to be considered. Children can be evaluated for these symptoms, though they may not be able to use the same language an adult might describe their symptoms. The treatment process may vary considerably based on the age of the person in question. If some of these symptoms appear familiar but others do not, an online quiz can help clarify some of the confusion that frequently surrounds Gender Dysphoria.

Dysphoria Is The DSM: Gender Dysphoria Treatment

Treatment for Gender Dysphoria varies widely, just as the symptoms of Gender Dysphoria vary widely in how they are expressed and what they entail. Psychotherapy is typically the first line of treatment for Gender Dysphoria. People dealing with these symptoms often need time and a safe space to work through all of the complicated feelings that accompany Gender Dysphoria. During therapy sessions, people with the condition may decide to pursue various biological treatment options, including gender reassignment surgery, hormone treatments, and suppressors, or simply a continued exploration of gender identity and the many ways that can affect daily life behaviors, and communication habits. For some, treatment involves biological intervention. For others, treatment focuses on creating comfort within a given gender identity while developing healthy coping mechanisms for any difficulties people with Gender Dysmorphia may face.

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Treatment will also vary depending on the age of the patient in question. In children, Gender Dysphoria typically involves a much larger team of professionals to ensure that a child’s mental and physical health is kept at a high priority during the therapy process. For some children, gender identity is considered so thoroughly instilled, hormone treatments are considered the next step in therapy. In contrast, for other children, parents, children, and other interdisciplinary team members decide to wait before choosing any hormonal interventions, and essentially monitor the child’s wants and needs over time.

Treatment for Gender Dysphoria has proven something of a hot-button topic, as insurance companies may cover therapy. Still, other forms of intervention may not, despite a therapist’s urging or suggestion that these treatments be considered an integral part of healing. People without access to insurance or who have limited access to care may only be able to receive talk therapy or other psychotherapy services, rather than a comprehensive treatment plan, and may continue to experience some degree of distress as a result of dysmorphic symptoms until a more robust treatment plan is provided.

Gender Identity Disorder: Next Steps

Is Gender Dysphoria a mental illness? This question has been steeped in controversy and does not have a simple or easy answer. Gender Dysphoria is considered a mental illness in that it is a mental state that causes a great deal of distress to individuals who are experiencing symptoms. Still, treatment may not seek to eliminate symptoms, but instead encourage patients to seek gender reassignment surgery or hormonal treatments as part of their path to recovery. Gender Dysphoria is not considered a mental illness, too, in that feeling at odds with biological sex does not indicate that an individual is in some way impaired, damaged, or in need of “fixing.” The discussion surrounding Gender Dysphoria and its inclusion in the DSM has long been filled with controversy and confusion, much of it from medical professionals and some of it from the very people who qualify as Gender Dysphoric.

As it stands, Gender Dysphoria is a recognized condition. This means that, according to many major insurance companies and mental health practices, Gender Dysphoria qualifies for insurance coverage and is a legitimate reason to seek out the services of therapists and mental health clinicians. The degree of coverage can vary dramatically from company to company and will vary dramatically from patient to patient. Some patients are content with a continual psychotherapy regimen. In contrast, others will seek hormonal intervention or even sex reassignment surgeries as part of a full treatment plan for their dysphoric symptoms. In all of these cases, needs and wants will be weighed carefully between mental health professionals and their patients to provide the safest and most effective care method.