Gender Dysphoria

What is gender dysphoria

Distress that may accompany incongruence between experienced or expressed gender and assigned gender

Is being transgender itself a mental disorder

No / the DSM diagnosis focuses on clinically significant dysphoria rather than gender identity itself

What is the core feature of gender dysphoria

Marked incongruence between assigned gender and experienced or expressed gender plus clinically significant distress or impairment

Does gender incongruence alone establish gender dysphoria

No / clinically significant distress or impairment is also required

How long must gender dysphoria symptoms persist

At least 6 months

Are the diagnostic criteria the same for children and adults

No / DSM uses separate criteria for children and for adolescents and adults

What is gender identity

A persons identification as male / female / another gender / or a gender between or outside traditional binary categories

What does transgender mean

A broad term for people whose gender identity differs from their birth assigned gender

What does cisgender mean

Gender identity or expression is congruent with birth assigned gender

What is gender nonconforming behavior

Behavior or characteristics that differ from what is statistically typical for people of the same assigned gender within a particular culture and historical period

Does gender nonconforming behavior by itself establish gender dysphoria

No

What are gender affirming treatments

Medical interventions such as hormones or surgery intended to align physical characteristics with experienced gender

How many symptoms are required for gender dysphoria in children

At least 6 of 8

What additional symptom rule applies to gender dysphoria in children

The strong desire or insistence of being another or alternative gender must be one of the symptoms

What is the required child Criterion A1

A strong desire to be another gender or insistence that one is another or alternative gender different from assigned gender

What clothing related symptom can occur in childhood gender dysphoria

Strong preference for clothing associated with another gender or strong resistance to clothing associated with assigned gender

What fantasy play symptom can occur in childhood gender dysphoria

Strong preference for cross gender roles in make believe or fantasy play

What toy and activity symptom can occur in childhood gender dysphoria

Strong preference for toys / games / or activities stereotypically associated with another gender

What peer preference can occur in childhood gender dysphoria

Strong preference for playmates of another gender

What rejection of gender stereotyped activities can occur in childhood gender dysphoria

Strong rejection of toys / games / or activities stereotypically associated with assigned gender

What anatomy symptom can occur in childhood gender dysphoria

Strong dislike of ones sexual anatomy

What physical characteristic desire can occur in childhood gender dysphoria

Strong desire for primary or secondary sex characteristics matching experienced gender

What functional requirement applies to childhood gender dysphoria

Clinically significant distress or impairment in social / school / or other important functioning

What is the high yield childhood gender dysphoria formula

At least 6 of 8 symptoms for at least 6 months plus distress or impairment and the desire or insistence of another gender must be included

How many symptoms are required for gender dysphoria in adolescents and adults

At least 2 of 6

How long must adolescent or adult gender dysphoria persist

At least 6 months

What is the first adolescent and adult gender dysphoria symptom

Marked incongruence between experienced gender and primary or secondary sex characteristics

What is the second adolescent and adult gender dysphoria symptom

Strong desire to be rid of primary or secondary sex characteristics because of gender incongruence

How may the second criterion appear in a young adolescent

Strong desire to prevent development of anticipated secondary sex characteristics

What is the third adolescent and adult gender dysphoria symptom

Strong desire for primary or secondary sex characteristics associated with another gender

What is the fourth adolescent and adult gender dysphoria symptom

Strong desire to be another or alternative gender different from assigned gender

What is the fifth adolescent and adult gender dysphoria symptom

Strong desire to be treated as another or alternative gender

What is the sixth adolescent and adult gender dysphoria symptom

Strong conviction that one has feelings and reactions typical of another or alternative gender

What functional requirement applies to adolescent and adult gender dysphoria

Clinically significant distress or impairment in social / occupational / or other important functioning

What is the high yield adolescent and adult gender dysphoria formula

At least 2 of 6 symptoms for at least 6 months plus clinically significant distress or impairment

What specifier can be used when gender dysphoria occurs with a difference of sex development

With a disorder or difference of sex development

What are examples of disorders or differences of sex development

Congenital adrenal hyperplasia / androgen insensitivity syndrome / chromosome abnormalities / other variations of reproductive development

What is the posttransition specifier

Person lives full time in experienced gender and has undergone or is preparing for at least one gender affirming medical treatment

Does posttransition require legal gender change

No

Does posttransition require surgery

No / regular gender affirming hormone treatment can meet the medical treatment component

Can someone have gender dysphoria without seeking hormones or surgery

Yes

Can a nonbinary or alternative gender identity satisfy gender dysphoria criteria

Yes / experienced gender does not have to fit a binary male or female identity

How does puberty affect gender dysphoria

Development or anticipation of secondary sex characteristics can intensify gender incongruence and distress

Can gender dysphoria begin in childhood

Yes

Can gender dysphoria first become apparent around puberty or later

Yes

Can childhood gender dysphoria continue into adolescence and adulthood

Yes

Does childhood gender dysphoria always persist into adulthood

No

Can gender dysphoria recur after previously decreasing or remitting

Yes

What factors may influence distress associated with gender dysphoria

Social acceptance / family support / discrimination / victimization / access to desired treatment / physical changes

Can a supportive environment reduce psychological distress

Yes / distress may be less evident when gender diversity is accepted and supported

What social problems may contribute to impairment in gender dysphoria

Peer rejection / harassment / discrimination / school difficulties / work difficulties / relationship problems / social isolation

Is distress caused by stigma identical to gender dysphoria

No / stigma related distress is conceptually distinct although it may occur at the same time

Why is the distinction between dysphoria and stigma clinically important

A person may experience distress from discrimination without meeting criteria for gender dysphoria

How does gender dysphoria differ from ordinary gender nonconformity

Gender nonconformity alone lacks the required pattern of gender incongruence plus clinically significant distress or impairment

Should stereotypically masculine behavior in a girl or feminine behavior in a boy automatically suggest gender dysphoria

No

How does gender dysphoria differ from transvestic disorder

Transvestic disorder involves sexual arousal from cross dressing without necessarily questioning assigned gender while gender dysphoria involves gender incongruence and distress

Can gender dysphoria and transvestic disorder both be diagnosed

Yes / when criteria for both are independently met

How does gender dysphoria differ from body dysmorphic disorder

Body dysmorphic disorder involves belief that a body feature is defective or unattractive while gender dysphoria concerns incongruence between body characteristics and experienced gender

Can gender dysphoria and body dysmorphic disorder occur together

Yes

How can autism complicate assessment of gender dysphoria

Rigid or concrete thinking about gender and social relationships may make it harder to distinguish an autistic preoccupation from co occurring gender dysphoria

Can autism and gender dysphoria coexist

Yes

How does gender dysphoria differ from a gender themed psychotic delusion

Psychotic beliefs typically occur within a broader psychotic episode and may be bizarre or fluctuate with psychosis while gender dysphoria is not inherently psychotic

Is stating that one is another gender considered a delusion in the absence of psychosis

No

Can schizophrenia and gender dysphoria coexist

Yes

What commonly co occurs with gender dysphoria in clinically referred children

Anxiety disorders / depressive disorders / disruptive disorders / impulse control disorders

What mental disorders commonly co occur with gender dysphoria in adolescents and adults

Anxiety disorders / depressive disorders

What trauma related disorder may occur following harassment or violence

PTSD

Is suicide risk elevated among people presenting with gender dysphoria

Yes

What factors are associated with increased suicide risk in the chapter

Maltreatment / gender related victimization / depression / substance misuse / younger age

Why should suicide assessment be important when working with gender dysphoria

The chapter describes elevated rates of suicidal thoughts / suicide attempts / and self harm among clinically referred populations

Can mental health problems continue after gender affirming treatment

Yes / adjustment varies and some individuals continue to experience anxiety / affective symptoms / or suicide risk

What is other specified gender dysphoria

Clinically significant gender dysphoria symptoms that do not meet full criteria when the clinician states why

What is an example of other specified gender dysphoria

Brief gender dysphoria in which full symptom criteria are present for less than 6 months

What is unspecified gender dysphoria

Clinically significant gender dysphoria symptoms that do not meet full criteria when the clinician does not specify why or lacks sufficient information

What is the highest yield child versus adult shortcut

Children = 6 of 8 with the desire or insistence criterion required / adolescents and adults = 2 of 6

What is the highest yield duration rule for gender dysphoria

At least 6 months for both children and adolescents or adults

What is the single most important diagnostic shortcut for gender dysphoria

Gender diversity or transgender identity alone is not the disorder / diagnosis requires gender incongruence with clinically significant distress or impairment