Gender dysphoria: recognition and assessment

Abstract

SummaryThe role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this article considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.

Gender dysphoria: treatment and outcomes

“…In the first of our articles on gender dysphoria in this issue (Eden 2012), we discussed recognition and assessment of the condition. Here we consider the role of the gender specialist in its treatment.…”

“…In addition, patients should demonstrate that they have further consolidated their preferred gender identity through experience living in an identity-congruent gender role or psychotherapy. As discussed in our previous article (Eden 2012, this issue), they should also have made progress in tackling any mental health or other identified problems (World Professional Association for Transgender Health 2011). The readiness criteria for genital surgery are similar: that progress has been made in consolidating the new gender identity and that comorbid problems have been addressed.…”

Childhood abuse and depressive vulnerability in clients with gender dysphoria

“…Since gender variance itself may not be problematic for many gender non‐conforming people, but GD is, the latter is the preferred term for purposes of this paper. Also, a diagnosis of GD is relevant to distinguish it from depressive illness, which may be concurrent, or present but without GD (see also Ahmad et al, 2013; Eden, Wylie & Watson, 2012).…”

Supporting trans people in clinical practice

“…7 As such, they experience incongruence between the gender they identify themselves as having (gender identity) and the sex assigned to them at birth. 8 It is important to note that gender identity is independent of an individual's sexual orientation relating to sexual attraction.…”

“…The latest revision of the American manual (DSM-5) has made progress in depathologising transgenderism, an issue that has been hotly debated. 12,7 Diagnosis of gender dysphoria (previously gender identity disorder) is dependent on an individual experiencing persistent incongruence between their experienced and assigned gender, and a strong desire to be the opposite gender that causes clinically significant distress or impairment in functioning. 12 Notably, the etiology of gender incongruence remains unknown.…”