The Mental Disorder Debate on Gender Dysphoria

Gender dysphoria refers to the feeling of extreme discomfort or distress that someone experiences when their gender is out of line with their assigned sex at birth. This lack of correspondence may be more or less painful for mental health and social relations and, in particular, for personal identity. However, is gender dysphoria a mental disorder? It’s a complex answer rooted in the history of gender dysphoria, its classification and the changing perspectives on mental health.

All you need to know about gender dysphoria:

Gender dysphoria defines a strong sensation that a person’s true gender differs from their body or the external appearance of their belonging to society. As an example, someone who is assigned female at birth may be male or nonbinary and feel that their gender does not align with the body they were born into. This disconnection might present such mental anguish that someone may try to find relief from it with gender-affirming treatments like hormone therapy, surgeries, or social transitions.

We need to differentiate between what this dysphoria is and the other things one might identify their sex with. And in fact, gender identity itself—whether someone identifies as male, female, nonbinary, or another gender—is not a mental illness. Instead, it is a normal part of being human. Gender dysphoria is a type of psychological distress that occurs when someone’s gender identity does not align with the sex assigned to them at birth.

Gender Dysphoria in the DSM-5: A Diagnostic Classification

Gender dysphoria, as a mental health diagnosis, is included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), published by the American Psychiatric Association (APA). Here, sex identity is no longer labelled as “disorder,” but the combination of one’s mental state and body that doesn’t match up with each other can cause emotional disconnectedness or stressfulness. Gender dysphoria, if formally recognized as real psychological suffering, can gain access to medical treatments and insurance coverage.

As per DSM-5 Identity Disorder Gender (formerly known as gender identity disorder) is a psychiatric condition that occurs when someone feels that there is an important conflict between the person’s experienced or expressed gender and their sex assigned at birth, leading to significant distress, social impairment, or dysfunction. Diagnosis is based on some of the following: an intense wish to be of the opposite gender, distress with primary or secondary sex features, desire for characteristics other than those of one’s assigned gender. People are diagnosed when these feelings create clinically significant distress or reduce social, occupational, or other important areas of functioning.

Changing Views: A Mental Disorder or a Medical Condition

At one point, gender dysphoria was classified as a mental disorder and then became a part of sexual identity disorder due to the evolution of society’s perception of gender and mental illness classification. Previously, “Gender Identity Disorder” was used in the DSM for people whose identity did not match the sex assigned at birth. In the meantime, this term was criticized for pathologizing gender identity as such and thus causing stigma and misunderstandings.

The WHO also took steps toward destigmatizing gender incongruence across the globe. The WHO revised its International Classification of Diseases (ICD-11) to move “gender incongruence” out of the section on mental health disorders and into a new chapter entitled “Conditions Related to Sexual Health.” It calls attention to the understanding that not adhering to a cisgender identity is not inherently a pathology and that the psychosocial distress from this dysphoria should be handled as any other somatic illness.

Gender Dysphoria Effects on Mental Health

Gender dysphoria itself is not a mental illness per se; it has serious implications for mental health. Gender dysphoria can cause psychological problems, including depression and anxiety, along with suicidal thoughts in some cases.

Individuals with gender dysphoria also may have co-occurring mental health conditions, and much of the risk stems from social problems he or she will face. The experience of stigma and discrimination can lead to social isolation (and the risk of rejection by friends and family), making mental health problems more likely. However, these mental health conditions are not necessarily due solely to the gender identity of a person but more so around the distress that comes with navigating societal challenges and acceptance hurdles.

Treatment Can Take Away Some Pain

Handling of gender dysphoria typically includes pieces of methods that can be called gender-affirming concern — including for hormone therapy, so surgical focuses on for sex selection and gift transition. Such treatments are meant to align the outward appearance of a person with how he or she identifies as male or female so that distress is reduced. Another essential component of treatment that supports therapies is psychological support (such as counseling), which assists an individual in coping with social difficulties and adjusting to the transition during this process.

Numerous studies indicate that those with these treatments have higher life satisfaction, mental health, and quality of life. This only adds to the evidence that gender dysphoria probably is not a mental disorder itself but instead arises from a discordance and accompanying distress between identity and body.

Classification Still Matters When It Comes To Accessing Medical Care

The main reason gender dysphoria is still categorized in the DSM has to do with access for medical care and insurance coverage. This could be an explanation for why, without formal diagnosis, quite a number of insurance companies may deny coverage on gender-affirming facial surgeries or some of them indeed view these treatments as elective or cosmetic surgery instead of necessary proper care. For those suffering from gender dysphoria, access to these treatments can be life-saving and reduce distress symptoms while improving mental health.

But in this context, the fact that this dysphoria remains categorized as a mental health diagnosis is functional — even if practitioners strive to not pathologize trans identities and experiences, having access to appropriate care frequently depends on a specific diagnosis. The diagnosis is meant to clear a path for support rather than simply ascribing mental illness based on gender identity.

Battling the Stigma of Gender Dysphoria

Stigma is one of the big issues facing people who experience gender dysphoria. Further, this ambiguity often leads to misunderstanding and exclusion, making access to care that much more difficult for these individuals. For medical and mental health professionals, reducing stigma and improving public understanding of the condition that underlies it is also a main part of what they’re doing by clarifying that gender dysphoria is about the distress associated with, not non-cisgender identities themselves being “disordered.“

Moreover, supporters and practitioners underline the significance of using appropriate language and respectful interaction with people who have gender dysphoria. This could be using pronouns that people would like others to refer to them as, not making assumptions based on their appearance if an individual is a certain gender, and helping others understand the difference between being trans, non-binary, and having mental health conditions.

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