Gender dysphoria is a type of mental disorder in which the patient does not recognize their gender identity and believes that their gender is the opposite of their biological sex. The condition is related to genetic factors, hormone imbalances, or environmental influences that lead to a distorted perception of gender.
Understanding biological sex, gender identity, and sexual orientation
Gender dysphoria is a psychological issue related to gender identity perception, and therefore to better understand this condition, it is necessary to accurately grasp the concepts related to biological sex, gender identity, and sexual orientation of humans. While these concepts are widely discussed today, not everyone can fully comprehend them.
Biological sex: This refers to the gender recognized at birth through anatomical factors of the reproductive system, chromosome testing, or hormones. The two genders specifically identified through these factors are male or female. However, biological sex also includes intersex if there are abnormal changes in chromosomes and reproductive organs that do not match the characteristics of either male or female.
Gender identity: This is the inner feelings and thoughts of each person about their gender tendencies, believed to be directly related to environmental and social factors. Gender identity may not coincide with biological sex, for example, a person may be female but identify as male and express this through dress, makeup, hairstyle, actions, and gender-specific norms. Gender dysphoria may be related to this issue.
Sexual orientation: This is the tendency of emotional and sexual attraction between one person and another. Typically, it is believed that two different gender individuals will be attracted by sexual orientation, but not all cases are like that. The three common concepts used for sexual orientation are heterosexual (attracted to different genders), homosexual (attracted to the same gender), and bisexual (attracted to both genders).
Previously, society often believed that a normal person needed to live according to their biological sex, have romantic and sexual relationships with the opposite sex, and have children naturally. Having a same-sex tendency, being attracted to the same gender was considered abnormal, deviant and needed to be eliminated.
However, as society has developed, studies have been conducted, and the perception of sexual orientation has become more open, accepting a new concept of gender known as “the third gender”. Nevertheless, there are still many controversies and shortcomings in the dissemination and perception of gender-related issues leading to a psychological problem called “gender dysphoria.
What is gender identity disorder?
Gender Identity Disorder (GID), also known as gender dysphoria, is a condition where an individual experiences a mismatch between their gender identity and their biological sex, and desires for others to recognize and treat them as their preferred gender.
In 2013, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) renamed gender identity disorder to “gender dysphoria” due to concerns that the previous term carried stigmatizing connotations, although the term is still widely used.
According to experts at the American Psychological Association (APA), the most important factor in this type of mental disorder is a strong sense of distress and discomfort experienced by individuals who identify with a gender that is different from their assigned gender. However, it is important to note that gender dysphoria does not necessarily mean that these individuals are homosexual, which is a common misunderstanding.
Furthermore, in 2022, the new version of the International Classification of Diseases (ICD-11) changed the classification of this condition to “conditions related to sexual health” and renamed this type of mental disorder to “incongruence of gender identity”. Although this concept is similar to DSM-5, it does not include other psychological distress.
To express their gender identity more clearly, these individuals often try to change their hairstyle, clothing style, way of speaking, and break the norms associated with their assigned gender. At the same time, they want others to accept their gender identity and feel extremely uncomfortable if someone categorizes them based on their current gender characteristics.
Some studies suggest that about 0.005-0.014% of boys and 0.002-0.003% of girls meet the criteria for Gender Identity Disorder from birth, while others do not identify with their assigned gender and may want to undergo gender transition but do not meet the criteria.
In general, gender dysphoria is a complex issue that poses difficulties for experts in confirming whether someone is transgender or simply has a different perspective on gender. Many individuals struggle to self-identify, leading to mistakes such as undergoing gender transition or other related issues.
Some classifications of syndromes of disorders of gender development
Some classifications of gender dysphoria include a wide range of characteristics and are commonly categorized according to various diagnostic criteria. For example, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the term “Gender Dysphoria” can be classified into the following types:
Top Dysphoria: discomfort and dissatisfaction with the upper part of the body, such as shoulders, chest, arms, neck, etc. For example, a female may feel uncomfortable with breast development while a male may feel dysphoric about having broad shoulders that are not slender like those of females.
Bottom Dysphoria: similar to top dysphoria, this term describes the discomfort of individuals with gender dysphoria with the lower part of their body, which typically includes the genital area.
Social Dysphoria: the discomfort of individuals with gender dysphoria with the gender norms imposed by society, especially with regard to themselves. For example, a trans woman may dislike having a masculine and strong name. On the other hand, individuals who identify as transgender or non-binary tend to experience more social dysphoria than physical dysphoria.
However, in the International Classification of Diseases, Eleventh Revision (ICD-11), gender dysphoria is classified with the following characteristics:
F64.0. Transsexualism F64.1. Dual-role transvestism F64.2. Gender identity disorder of childhood F64.8. Other gender identity disorders F64.9. Gender identity disorder, unspecified
As of early 2022, the ICD has made some new adjustments, not only in the names but also in the addition and replacement of some characteristics of “Gender Incongruence” as follows:
HA60. Gender incongruence in adolescents or adults (replacing F64.0) HA61. Gender incongruence in childhood (replacing F64.2) HA6Z. Gender incongruence, unspecified time period (replacing F64.9)
Symptoms of gender identity disorder
The symptoms of gender dysphoria are extremely clear and can appear as early as childhood with characteristics of rejecting one’s biological sex in every behavior, thought, and emotion. These perceptions grow stronger over time, especially in an era where society is becoming more open to the LGBT community, which increases their desire to express their “true gender.
Specifically, some specific manifestations of people with this mental disorder include:
- A clear desire to be recognized as a different gender than their biological gender on their current legal documents.
- Suffering, frustration, discomfort, and irritation because they identify with a gender other than their biological gender. For example, a woman who wants to identify as a man may cut her hair short, dress like a man, or vice versa; a man who wants to identify as a woman may grow long hair, wear dresses, and high heels.
- Engaging in behaviors similar to the gender they identify with, such as sitting to urinate for boys or wearing a chest binder to prevent breast development for girls.
- Wanting to participate in activities, games, and jobs that the other gender can do.
- A strong desire to have a specific characteristic of the opposite gender and to be recognized for it. For example, a woman may desire a beard like a man’s.
- People with gender dysphoria tend to dislike their own reproductive organs (as it is one of the factors to express their biological gender), and may wish to escape from them or even tend to want to destroy their own reproductive organs to reject their identity.
- Identifying themselves as homosexual, having emotional and sexual attraction to someone of the same gender.
- Feeling lonely, and may think that they can become someone of the gender they desire when they grow up.
- May experience social isolation, especially in children, because they exhibit unusual behaviors while those around them may not have enough understanding about gender. In fact, even in modern societies, adults who belong to the third world or have gender dysphoria can still be isolated and subject to a lot of gossip.
- Tending to seek medical intervention to change their gender, such as surgery, hormone injections, and a host of other interventions.
The causes of gender dysphoria
As mentioned, issues related to gender dysphoria are often complex and multifaceted. Gender distress is also considered a form of gender variance as it is influenced by many factors, especially the environment, society, and hormonal issues. If not promptly controlled, this condition can lead to serious consequences in a person’s life.
Specifically, according to experts, factors directly related to gender dysphoria include:
Genetic factors: up to 62% of studies indicate that gender identity is directly related to genetic factors, likely due to abnormal genes or chromosomes. This conclusion was reached after finding a higher prevalence of gender dysphoria in monozygotic twins compared to dizygotic twins.
Hormonal disorders: hormones are also directly related to gender identity, but if they become disrupted, for example, if testosterone levels increase in a person who identifies as female, it can lead to gender dysphoria.
Family education: Many families desire a specific gender for their child, and when the child is born with a different gender, disappointment may arise. To fulfill their desires, many parents choose to dress their child and give them toys that are typical of the gender they desire. For example, if they want a son but have a daughter, they may cut her hair short, have her play with superhero toys, play soccer, and have a masculine appearance. Over time, this may create psychological problems for the child who may feel pressure to identify with a gender that does not match their biological sex.
Environmental influences: Nowadays, many children develop gender dysphoria due to the influence of their living environment and the information they find on the internet before they have a full understanding of gender. For example, children who interact with many LGBT individuals and see them being praised and celebrated by society may feel that they belong to a different gender and not their biological sex.
However, these factors are still only hypotheses put forward by scientists, without a precise conclusion on the mechanisms and causes of these psychological disorders. This also has a significant impact on accurately diagnosing and treating gender dysphoria.
Problems in diagnosing gender identity disorder
The issues in diagnosing gender identity disorder are extremely complex and have caused a lot of debate since they were first introduced. Many people often confuse gender dysphoria with individuals from the third gender, but this is not entirely accurate. Others believe that gender identity disorder is the same as being transgender, but the characteristics of these two conditions are not entirely consistent.
One of the most prominent features of Gender Identity Disorder is extreme distress, to the point of wanting to destroy the genitalia that are believed to be incorrect. Meanwhile, transgender individuals tend to accept this and may undergo gender transition surgery to live as their true gender.
Moreover, the sexual tendencies of these groups are also entirely different when exposed to a stimulus. Additionally, gender identity disorder is not the same as disorders of sexual differentiation (in which a child is born with both male and female genitalia).
In general, there are still many issues surrounding gender identity disorder that have not been clearly discussed, leading to confusion about one’s gender identity and difficulties in diagnosis. Patients need to seek out psychiatric specialists or psychological centers to undergo testing and specialized examinations to reach the most accurate conclusion.
Is gender identity disorder dangerous?
Mistakenly identifying oneself as having a different gender identity can lead many people to undergo gender transition surgery. Furthermore, with modern society becoming more accepting of individuals who identify as third gender, those with gender identity disorder may categorize themselves as such rather than accepting that they have psychological or psychiatric issues.
The distress of societal expectations, along with serious psychological struggles such as feelings of insecurity, social isolation, negative emotions, and a host of other problems, accompany the discomfort about gender identity. The distress caused by gender dysphoria can make individuals hate themselves, and even engage in self-destructive behavior that endangers their own lives.
Depression and severe stress are extremely common problems among “Gender Non-Conforming” individuals. Furthermore, behaviors that deviate from the norm, such as sitting to urinate for male-bodied individuals, often lead to stigmatization, isolation, and violent attacks that further exacerbate their negative psychological state, leading to more self-destructive tendencies.
Treatment for Gender Dysphoria
The two primary approaches commonly employed for gender identity disorders are medical treatment and psychological care. Experts recommend that patients should combine both methods and adhere to a healthy lifestyle for the treatment to be effective.
In general, the goal of these treatments is to help individuals arrive at a correct understanding of their gender identity, accept themselves as they are, and alleviate the distress they feel about their gender identity. It should be noted that the effectiveness of treatment will vary in each case and depends on each person’s response to treatment.
Treating gender identity disorders is also complicated, such as using medication to adjust hormones that are out of balance, and medications to support patients with symptoms of depression or other psychological issues. However, it is clear that medication only helps to alleviate emotions, improve energy, and cannot change an individual’s thoughts about their gender.
Previously, some treatment approaches believed that the best way to help people with gender dysphoria was gender reassignment surgery to meet their gender needs, which would reduce psychological distress for patients. However, some opinions reject this method because they think gender reassignment only addresses “biological impotence” and may not satisfy all patients emotionally.
Moreover, gender dysphoria is assessed by the specialist community as a mental health condition, while gender reassignment surgery only changes external structures, not the beliefs firmly held by the patient. Not to mention that some patients who undergo surgery at “underground” cosmetic facilities have caused serious complications to their own lives.
Legalizing gender reassignment surgery is considered an encouraging act for mentally ill patients. Currently, many hospitals refuse to perform gender reassignment surgery because of these controversies. Nevertheless, some patients still have a desire to make some adjustments to their bodies, such as reducing roughness on the facial contour, which can still be acceptable to some extent.
Gender dysphoria is a psychological issue, so this is the main approach for patients. Some statistics show that this method can be effective in trying to convince patients to accept their current gender instead of craving the opposite gender, although it still depends on each cause and case.
Especially with a high suicide rate or self-harming behavior due to attacks on their dignity, isolation, psychological therapy is a necessary method to soothe the emotions of patients and accept their flaws to aim for more positive values in life. When patients feel more comfortable and remove their distress, they will gradually come to accept themselves.
For young children with gender identity disorders, psychotherapy is essential to eliminate any deviant behaviors or perceptions. On the other hand, through conversations with therapists, we can completely grasp the factors that make patients have distorted perceptions about gender, thereby finding the most suitable way to restore the damages in their minds.
In general, psychotherapy can be very helpful in relieving tension, seeing things correctly…