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Gender Dysphoria disorder
The main components of the DSM-5 diagnosis of gender dysphoria include longstanding discomfort with the incongruence between gender identity and external sexual anatomy at birth along with interference with social, school, or other areas of function (APA,2013). Children who have a gender identity or feeling that does not match or correspond with their designated gender (based upon genital anatomy or chromosomes) are referred to as transgender or gender-diverse (TGD) (Rafferty , 2018). Although not really clear how children learn gender, they are ware of differences as an infant, many experiment with expression of roles (Rafferty, 2018). Young (TGD) children may prefer clothing, hairstyles, toys, activities, and playmates that usually are stereotypically considered more appropriate for the opposite sex (Spack et al, 2012). Studies show demonstration of gender-diverse behaviors and expression are not a choice they reflect an innate preference of the child (APA, 2013). Strong social pressures to conform to same-sex gender stereotypes may suppress the child’s desire to express, and create the psychological issues related to this topic. Early identification permits psychosocial support for the child or adolescent and their family members and family rejection may have negative consequences for the youth physically and mentally (Ryan et al, 2021). There are many roles for treatment which is loosely defined, such as:
- Assessing gender identity in the context of the youth’s psychosocial and family milieu and evaluating extent of gender dysphoria
- Educating about and modeling acceptance of diversity and fluidity in gender and sexuality
- Addressing the negative impact of gender dysphoria and stigma on mental health alleviating internalized transphobia (ie, fear of gender diversity)
- Providing support and helping to build the resiliency/coping skills necessary to navigate difficult social, educational, and professional situations (see ‘Associated concerns’ above)
- Evaluating and treating mental health symptoms or conditions that may diminish self-esteem or impede successful transition (eg, depression, anxiety, substance abuse)
- Providing support to parents and family members who have difficulty adjusting to the child’s “new” identity
- Providing information about gender diversity to parents, family members, teachers, schools, and other communities
- Assisting in the development of a safety plan around disclosure (see ‘Disclosure’ above)
- Assisting in transition preparation and planning (see “Management of transgender and gender-diverse children and adolescents”, section on ‘Social transition’)
- RESOURCES – (WPATH, 2021).
Culturally it is noted that “How gender is presented to the outside world (eg, feminine, masculine, androgynous); gender expression does not necessarily correlate with birth-designated gender or gender identity. In addition, gender expression varies across geography, culture, and time. Some individuals may present their gender differently within different environments” ( Rafferty , 2018 , p.142).
American Psychiatric Association. Gender dysphoria. In: Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013.
Rafferty J, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY
HEALTH, COMMITTEE ON ADOLESCENCE, SECTION ON LESBIAN, GAY,
BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS. Ensuring
Comprehensive Care and Support for Transgender and Gender-Diverse Children and
Adolescents. Pediatrics 2018; 142.
Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health
outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 2009.
123:346. Retrieved February 10, 2021 from: https://www.uptodate.com/contents/gender-
Spack NP, Edwards-Leeper L, Feldman HA, et al. Children and adolescents with gender identity
disorder referred to a pediatric medical center. Pediatrics 2012; 129:418.
World Professional Association for Transgender Health (WPATH). WPATH Standards of Care
for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th
Version. Available at: