51 Gender Dysphoria
Alexandria Lewis
Content Outline, Competency, and KSAs
II. Content Outline: Assessment and Intervention Planning
IIB. Competency: Assessment Methods and Techniques
KSAs:
– The use of the Diagnostic and Statistical Manual of the American Psychiatric Association
Source of information about DSM diagnoses: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
overview
Gender dysphoria is the distress that arises from a significant mismatch between a person’s experienced or expressed gender and the gender they were assigned at birth. While not everyone with this incongruence experiences distress, those who do may struggle emotionally, socially, and physically. The DSM-5-TR emphasizes that the focus is on the distress, not the identity itself. Gender dysphoria can occur in children, adolescents, and adults, each with developmentally appropriate features.
Associated Features:
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Individuals may attempt to minimize or conceal physical features of their assigned sex (e.g., binding breasts, using loose clothing, or shaving body hair).
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Adolescents may seek puberty blockers or hormone therapy, sometimes without medical supervision.
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Many adolescents and adults request gender-affirming medical interventions such as hormones or surgery.
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Increased risk of mental health issues, including suicidal thoughts and behavior, is observed prior to gender-affirming treatments.
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Supportive environments can significantly lower emotional and behavioral problems, especially in children and adolescents.
Gender Dysphoria in Children Criteria:
A. A marked incongruence between experienced/expressed gender and assigned gender, lasting at least 6 months, shown by at least SIX of the following (including Criterion A1):
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Strong desire to be another gender or insistence that one is another gender (or an alternative gender).
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In boys (assigned gender), preference for dressing in female clothes; in girls (assigned gender), preference for typical masculine clothing and resistance to feminine clothing.
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Preference for cross-gender roles in make-believe or fantasy play.
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Preference for toys, games, or activities stereotypically associated with the other gender.
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Preference for playmates of the other gender.
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In boys, rejection of masculine toys and activities; in girls, rejection of feminine toys and activities.
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Strong dislike of one’s sexual anatomy.
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Desire for the primary and/or secondary sex characteristics of one’s experienced gender.
B. The condition causes clinically significant distress or impairment in social, school, or other important areas of life.
Specify if:
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With a disorder/difference of sex development (e.g., congenital adrenal hyperplasia, androgen insensitivity syndrome).
Case Study
Sam, a 7-year-old assigned male at birth, consistently tells their parents and teachers that they are a girl. Sam prefers wearing dresses, playing with dolls, and role-plays as female characters during play. Sam becomes upset when referred to as a boy. Over the past year, these feelings and behaviors have been steady and have started to cause distress at school and at home.
Gender Dysphoria in Adolescents and Adults Criteria:
A. A marked incongruence between experienced/expressed gender and assigned gender, lasting at least 6 months, shown by at least TWO of the following:
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Incongruence between experienced/expressed gender and physical sex characteristics.
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Strong desire to remove one’s sex characteristics due to incongruence.
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Strong desire for the sex characteristics of another gender.
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Strong desire to be another gender (or an alternative gender).
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Strong desire to be treated as another gender (or alternative gender).
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Conviction of having the feelings and reactions of another gender (or alternative gender).
B. The condition causes clinically significant distress or impairment in social, occupational, or other important areas of life.
Specify if:
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With a disorder/difference of sex development.
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Posttransition (the person lives full-time in their experienced gender and has undergone or is preparing for gender-affirming medical treatment).
Case Study
Morgan, a 32-year-old assigned female at birth, has felt increasingly uncomfortable with her body, particularly her breasts and hips. Morgan describes a strong desire to have a flat chest and a more masculine appearance and often avoids looking at their body in the mirror. Morgan has begun living socially as a man and is seeking hormone therapy to help align their physical characteristics with their experienced gender. The distress is affecting Morgan’s confidence at work and in social relationships.
Key Differences Between Gender Dysphoria in Children vs. Adolescents and Adults Criteria
Children:
• Must show at least 6 symptoms, with a required strong desire or insistence they are another gender.
• Emphasis is on gender-typed behaviors and preferences (clothing, toys, playmates).
• Behavioral expression of gender is central, as physical puberty changes haven’t occurred yet.
• Gender identity may be more fluid, so diagnosis focuses on patterns that are persistent, consistent, and insistent.
• Distress often tied to social roles and expectations (e.g., school, family interactions).
Adolescents and Adults:
• Must show at least 2 symptoms; no specific symptom is required.
• Focus is on distress about primary and/or secondary sex characteristics.
• Distress often centers on the body and physical incongruence with experienced gender.
• Gender identity tends to be more stable and internalized by this stage.
• Individuals may seek medical interventions (hormones, surgeries) and legal changes to affirm gender.
• Distress also tied to social functioning and identity acceptance across different environments.
other specified gender dysphoria
This diagnosis is used when a person shows significant symptoms of gender dysphoria that cause real distress or problems in daily life, but they don’t fully meet the official criteria for gender dysphoria. Clinicians use this label when they want to explain why the full criteria aren’t met. For example, they might write “other specified gender dysphoria (brief gender dysphoria)” if someone has all the symptoms but hasn’t experienced them for the required six months.
unspecified gender dysphoria
This diagnosis is used when a person shows signs of gender dysphoria that cause significant distress or problems in daily life but don’t fully meet all the official criteria. It is chosen when the clinician decides not to explain why the full criteria aren’t met, or when there isn’t enough information available to make a more detailed diagnosis.
self-check
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