Gender Incongruence Diagnosis
These are the diagnostic criteria for Gender Incongruence in the DSM-V-TR (2022). Gender Dysphoria in this context is not synonymous with being transgender, and refers to the mental distress experienced by having a gender identity at odds with one’s physical body or lived gender. This distress has to be clinically significant for a diagnosis to be made.
Medical authorities recommend transitioning as the treatment for GD, as it is the only course of action that has proven effective in alleviating dysphoria. Some transgender people may not qualify for a diagnosis of Gender Dysphoria if their distress is not intense enough to be debilitating. They may still desire and benefit from transitioning.
“The DSM–5 articulates explicitly that “gender non-conformity is not in itself a mental disorder.” The 5th edition also includes a separate “gender dysphoria in children” diagnosis and for the first time allows the diagnosis to be given to individuals with disorders of sex development (DSD). DSM–5 also includes the optional “post-transition” specifier to indicate when a particular individual’s gender transition is complete. In this “post-transition” case, the diagnosis of gender dysphoria would no longer apply but the individual may still need ongoing medical care (e.g., hormonal treatment)”- from psychiatry.org.
DSM-5-TR Diagnostic Criteria for Gender Dysphoria in adults and adolescents
- A definite mismatch between the assigned gender and experienced/expressed gender for at least 6 months duration as characterized by at least two or more of the following present –
- A marked incongruence between experienced or expressed gender and gender manifested by primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
- A strong or persistent desire to rid oneself of the primary or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
- A strong desire to possess the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong feeling or conviction that he or she is reacting or feeling in accordance with the identified gender
- The gender dysphoria leads to clinically significant distress and/or social, occupational and other functioning impairment. There may be an increased risk of suffering distress or disability.
- The subtypes may be ones with or without defects or defects in sexual development.
In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.
DSM-5-TR Diagnostic Criteria for Gender Dysphoria in children
- A definite difference between experienced/expressed gender and the one assigned at birth of at least 6 months duration. At least six of the following must be present (one of which must be the first criterion):
- A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender)
- In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing
- A strong preference for cross-gender roles in make-believe play or fantasy play
- A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
- A strong preference for playmates of the other gender
- In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities
- A strong dislike of one’s sexual anatomy
- A strong desire for the physical sex characteristics that match one’s experienced gender
- The gender dysphoria leads to clinically significant distress and/or social, occupational and other functioning impairment. There may be an increased risk of suffering distress or disability.
- The sub-types may be ones with or without defects or defects in sexual development.
To Note:
While it’s less the case than it was with the DSM-IV or DSM-III, the diagnostic criteria listed above for children is still likely to produce a few false positives. Many trans children meanwhile may not meet the criteria – for instance, a trans girl who enjoys typically masculine activities but has an intense, debilitating desire to be female would meet only 2 or 3 of the 6 required criteria, despite being very likely to persist in a transgender identity. Whereas an effeminate boy who is repeatedly forced into masculine activities against his will and might express a desire to be a girl out of that frustration (and vice versa) would meet at least 5 and perhaps even all 6 of the required criteria, despite being unlikely to grow up to be transgender.
This is important in light of the frequently repeated claim that a 80-90% of transgender children grow out of their gender dysphoria and do not become transgender adults but instead gay or lesbian. Many of those studies were done on children diagnosed under the DSM-III (1980), III-R (1987) and IV (1994). The DSM-IV criteria in particular did not require children to express a desire to be the other sex in order to be considered transgender; they merely needed to exhibit a strong pattern of gender-atypical interests and behaviour (manifested in forms of play, preferred clothing, and gender of playmates), which in most cases has no bearing on their actual gender identity.
While the DSM-III did require children to express a strong and persistent desire to be the other gender, it was also published during a time where stereotypical gender roles were a lot more rigid than they are today. This raises the possibility that many of those children’s declarations of wanting to be the other sex were the result of their frustration with gendered restrictions, rather than distress at being a boy or girl per se.
Adults were likewise not immune to this conflation of gender stereotypes and identity. The DSM-III described gender dysphoria in girls as follows: “Girls with this disorder regularly have male peer groups, an avid interest in sports and rough-and-tumble play, and a lack of interest in playing with dolls or playing “house”.”
Today, we know such girls to be tomboys, not transgender boys. It is thus no surprise that the majority of such girls grew up to be perfectly content as women (and likewise for boys), but this result cannot be extrapolated to transgender children whose distress extends beyond merely having atypical interests for their sex, and who do not find this distress eliminated by merely being given the freedom to act and dress as they like.