Gender Dysphoria

Gender dysphoria is a technical term for the sense that one's body and one's true gender do not match. In clinical settings the term is used to diagnose chronic symptoms of physical and mental discomfort, uncertainty, and depression about one's gender, also known as gender anxiety. Gender dysphoria is most often understood as a state that exists somewhere between gender confusion, where one might not know one's gender, and transsexuality, where one transitions with sex reassignment surgery to the anatomical body one feels most comfortable occupying. Not all gender dysphorics are transsexuals, and many choose to live as the sex they believe themselves to be without the aid of sex reassignment surgery.

Gender dysphoria is often linked with gender identity disorder, which is the official name given it by the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV 1994), the manual of pathological psychic disorders first published by the American Psychiatric Association in 1952. While the DSM-I (1952) and DSM-II (1968) mentioned only transvestism, DSM-III (1980) classified the gender identity disorders—including transsexualism and childhood gender identity disorder—as psychosexual disorders arising out of the incongruity between a person's anatomic sex and what many clinicians now term "psychological" sex, that is, the gender a person identifies as his or his own. The DSM-IV simplified the group into a single category, gender identity disorder, and eliminated transsexualism.

Diagnosing gender dysphoria entails emphasizing physical and psychological symptoms and deemphasizing social or political critique. The DSM-IV underscores that there must be evidence of a strong and persistent cross-gender identification, defined as either the desire to be the other sex or the belief that one really is the other sex already. Gender dysphorics must be uncomfortable wearing so-called sex-appropriate clothing, and they also should enjoy "opposite sex" activities and interests. Gender dysphorics are often uncomfortable with their genitals or biological secondary sex characteristics, such as breasts, hair, or voice. They may desire hormones, surgery, or both in order to make their anatomical and biological sex correlate. The DSM-IV emphasizes that this discomfort has to be more than the desire to have the perceived social status of the other sex. Dysphorics bear the burden of convincing medical professionals that their condition is real: Their gender anxiety must be acute, significant, and obvious, and it should make normal everyday social, sexual, and occupational functioning difficult.

Because gender dysphoria is a medical diagnosis of a psychological disorder, it defines its sufferers as mentally ill patients requiring treatment by medical professionals. Responding to this, some intellectuals and gender activists object to the term, viewing it as a way for parents and doctors to manage the potential homosexuality of children. They suggest that gender dysphoria pathologizes the healthy and sensible objections many people have to the oppressive roles and norms of the sex-gender system. In this view, gender dysphoria is more accurately described as a version of the gender discomfort many, if not most, people experience on a daily basis. Those who share this view might question how many people are truly comfortable in their gender, or with the idea of a binary gender system. They might wonder how can the feeling of physical incommensurability with one's ideal gender be pathologized when so many people admit their everyday difficulty living up to feminine and masculine norms.

On the other side of the question are those in favor of access to the care and resources provided by a medical diagnosis. They point out that the availability of surgery requires the creation of a category of subjects whose request for sex reassignment can be seen as legitimate. They maintain that in order to create this category and make surgical "correction" available, these subjects have to be pathologized, thus defining the parameters of a sickness that medical technology can reasonably cure. They argue that while the pathologization of gender dysphoria stigmatizes those who experience extreme levels of discomfort with their social and sexual gender roles, it also allows more people access to sex reassignment than if such surgery was viewed as elective rather than as the necessary treatment of a medical condition.

Treatment now involves not only providing counseling and access to hormones and surgery but also understanding gender variance as a naturally occurring human condition, with an emphasis on addressing the discomfort and anxiety of gender dysphoria by viewing gender-variant people as members of families and social networks that also need to participate in the therapeutic process. Those on both sides of the question agree that a growing acceptance of the principle of gender variance by medical professionals and society as a whole is good for those suffering from gender dysphoria as well as for those who want to provide the best standards of medical and psychological care.

see also Gender Confusion; Transgender.

BIBLIOGRAPHY

Green, Jamison. 2004. Becoming a Visible Man. Nashville, TN: Vanderbilt University Press.

Lev, Arlene Istar. 2004. Transgender Emergence. New York: Haworth Clinical Practice Press.

Nelson, James L. 1998. "The Silence of the Bioethicists: Ethical and Political Aspects of Managing Gender Dysphoria." GLQ: A Journal of Lesbian and Gay Studies 4(2): 213-230.

Vitale, Anne. "Rethinking the Gender Identity Disorder Terminology in the Diagnostic and Statistical Manual of Mental Disorders IV." Available from http://www.avitale.com/hbigdatalkplus2005.htm.

                                                Jaime Hovey