Pioneers like Magnus Hirschfield and Harry Benjamin distinguished same-sex attraction from transsexualism and introduced hormonal treatments for gender transition.
The first editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders) did not mention gender identity. The term “transsexualism” was first introduced in 1980.
In 1994, DSM-IV replaced “transsexualism” with “gender identity disorder in adults and adolescence” to reduce stigma, but this continued to be controversial as it was seen as pathologizing identity.
DSM-5 Changes and Current Understanding:
In 2013, DSM-5 replaced “gender identity disorder” with “gender dysphoria,” focusing on distress related to gender identity rather than transgender identities themselves.
Gender non-conformity is not considered a mental disorder. DSM-5 also acknowledges gender dysphoria in children and allows diagnosis for individuals with disorders of sex development (DSD).
The term “post-transition” is used to indicate when an individual’s gender transition is complete, after which gender dysphoria diagnosis may not apply, but medical care might still be necessary.
Criteria for Gender Dysphoria in Adolescents and Adults:
The diagnosis requires a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least six months, with at least two of the specified criteria, including a strong desire to be of another gender or to be treated as another gender, and significant distress or impairment in key areas of functioning.
Disorders of Sex Development (DSD):
DSD refers to conditions where anatomical, chromosomal, or gonadal sex varies from typical male or female patterns. The term “intersex” is preferred by some.
Infants with DSD are often assigned a male or female sex, sometimes involving surgery, which is controversial.
Caveats and Considerations:
The diagnosis of gender dysphoria can help in accessing treatment but may also stigmatize by categorizing transgender people as mentally ill.
There’s a push to categorize transgender treatment under an endocrine/medical diagnosis rather than a psychiatric one.
TGNC (transgender and gender non-conforming) individuals were historically misdiagnosed with psychotic/mood disorders.
It’s important to differentiate between symptoms of personality disorders and the impact of an unsupportive environment on TGNC individuals.
Ruling Out Psychiatric Illness:
TGNC individuals may exhibit symptoms like impulsivity or mood lability due to unsupportive environments, not necessarily indicating a personality disorder.
No consistent evidence suggests psychiatric illness causes gender dysphoria, though other psychiatric disorders may coexist.
References:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
