Gender dysphoria

Gender dysphoria (GD) is the distress a person feels due to their birth-assigned sex and gender not matching their gender identity. People who experience gender dysphoria are typically transgender. Evidence from studies of twins suggests that gender dysphoria not only has psychological causes, but may have biological causes as well. The diagnostic label gender identity disorder (GID) was used by the DSM until its reclassification as gender dysphoria in 2013, with the release of the DSM-5. The diagnosis was reclassified to better align it with medical understanding of the condition and to remove the stigma associated with the term disorder. The American Psychiatric Association, publisher of the DSM-5, stated that gender nonconformity is not the same thing as gender dysphoria, and that 'gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.' Some transgender people and researchers support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender. Treatment for gender dysphoria may involve supporting the person through changes in gender expression. Hormone therapy or surgery may be used to assist such changes. Treatment may also include counseling or psychotherapy. Symptoms of GD in children may include any of the following: disgust at their own genitalia, social isolation from their peers, anxiety, loneliness and depression. According to the American Psychological Association, transgender children are more likely to experience harassment and violence in school, foster care, residential treatment centers, homeless centers, and juvenile justice programs in comparison to non-transgender children. Adults with GD are at an increased risk for stress, isolation, anxiety, depression, poor self-esteem, and suicide. Studies indicate that transgender people have an extremely high rate of suicide attempts; one study of 6,450 transgender people in the United States found 41% had attempted suicide, compared to a national average of 1.6%. It was also found that suicide attempts were less common among transgender people who said their family ties had remained strong after they came out. However, even transgender people with a comparatively low risk were still much more likely to have attempted suicide than the general population. Transgender people are also at heightened risk for eating disorders and substance abuse. Gender dysphoria in those assigned male at birth tends to follow one of two broad trajectories: early-onset or late-onset. Early-onset gender dysphoria is behaviorally visible in childhood. Sometimes, early-onset gender dysphorics identify as gay for a period of time. This group is usually attracted to men in adulthood. Late-onset gender dysphoria does not include visible signs in early childhood, but some report having wishes to be female in childhood that they did not report to others. Those who experience late-onset gender dysphoria will often be attracted to women and may identify as lesbians. Before transition, they will frequently engage in transvestic behavior with sexual excitement. In those assigned female at birth, early-onset gender dysphoria is the most common course. GID exists when a person suffers discontent due to gender identity, causing them emotional distress. Researchers disagree about the nature of distress and impairment in people with GID. Some authors have suggested that people with GID suffer because they are stigmatized and victimized; and that, if society had less strict gender divisions, transsexual people would suffer less. A twin study (based on seven people in a 314 sample) suggested that GID may be 62% heritable, indicating the possibility of a genetic influence as its origin, in these cases.