Gender Dysphoria and the Mismatch Between Sex and Gender

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Is Gender Dysphoria a Mental Illness? All Myths Debunked Regarding the Mind-Body Problem

Dysphoria comes from the Greek word ‘dusphoria’ and refers to the state of unease or generalized dissatisfaction, feelings of restlessness, and anxiety with life. Gender Dysphoria, as the name suggests, is when an individual feels discontent with their assigned gender.

It is described as the feeling of discomfort or distress that might occur in people when their gender identity does not match the gender they are assigned at birth. So, what is the difference between sex and gender? What does it feel like to experience gender dysphoria? Read on the article to find out.

What is Gender Dysphoria? 

First thing’s first, what is the definition of gender dysphoria? According to the fourth version of the Diagnostic Statistical Manual of Mental Disorders or DSM, it is defined by strong, persistent feelings of identification with another gender and discomfort with one’s own assigned gender and sex.

Gender dysphoria involves a conflict between an individual’s physical gender and the gender that she/he/they identify with. For example, a person may be born with physical genitals that biologically assign them as a male at birth, but they may privately identify themselves with the female gender and may express sentiments like “ I feel like a woman trapped in a man’s body”. People with gender dysphoria often experience significant distress and problems associated with the way they feel or think of themselves, being severely uncomfortable within their own bodies. This sense of unease or dissatisfaction is maybe sometimes so intense that it leads to depression and anxiety and overall has a harmful impact on life.

To understand more clearly, think of the following analogy. Imagine having to wear your left shoe in your right foot, and your right shoe in your left foot, but never taking them off. Obviously, you will experience discomfort and unease and a strong desire to get rid of the shoes and wear them correctly. You cannot run or walk properly, so you can’t be your true self and play sports to your best ability because you have shoes on like that. While sitting down or getting distracted, you may momentarily forget about them, but the moment you start walking, the discomfort will again become noticeable to you. Gender dysphoria is like that feeling of unease and discomfort, just a hundred times worse.

Gender dysphoria is not related to sexual orientation or preference. Sexual orientation is a separate dimension from either sex or gender. Sexual orientation refers to the sex of the people one is attracted to, regardless of one’s own sex or gender. Thus, a person can identify as being a male and have a sexual preference for other males.

So, gender dysphoria is not the same as being gay or lesbian.
Also, gender dysphoria is not to be confused with gender non-conformity, which refers to the behaviors not matching gender norms or stereotypes of the assigned gender at birth. Examples include girls dressing and behaving in ways more socially acceptable of boys. It is not the same as having gender dysphoria.

What Is the Difference Between Gender Identity and Sex?
Historically, the terms “sex” and “gender” have been used interchangeably in the literature, but their uses are becoming increasingly distinct, and it is important to know the difference between the two. “Sex” is the anatomy of an individual’s reproductive system, and secondary sex characteristics or in general terms, it refers to the biological differences between males and females, such as genitalia and other genetic differences.

“Gender” is more difficult to define. It can refer to the psychological experience of being a masculine or feminine person, and the role of female or male in society, known as a gender role. Sex is biologically defined whereas gender is based on socially constructed features.

For the vast majority of people, regardless of sexual orientation, psychological gender, and biological sex more or less line up. But for some people, there is a mismatch between sex and gender, and their genetically assigned sex does not line up with their gender identity. These people may refer to themselves as non-binary, transgender, or gender-nonconforming. 
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Is Gender Dysphoria a Mental Disorder?

Since this is an experience that few people can empathize with, it was earlier known as ‘gender identity disorder’. Due to the evolving scientific study of gender, it was later reclassified as gender incongruence or gender dysphoria. Thus, NO, gender dysphoria is NOT a mental illness. The mismatch between sex and gender is not caused due to psychological malfunctioning. However, it can lead to psychological issues like depression and anxiety. 

What Causes Gender Dysphoria?
Gender dysphoria is a complex variant of human behavior. Gender development is complex and there are still things that are not completely known or understood. Gender dysphoria is a grey area that psychology still struggles to resolve. There’s a lot of speculations about the biological underpinnings of the condition, but the exact cause of gender dysphoria is still unclear. Genes, hormonal influences in the womb, and environmental factors are all suspected to be involved.

 Gender Dysphoria in Children
Gender dysphoria can be seen as early as childhood. Children with gender dysphoria may wish to be of the opposite gender or may assert that they are (or will grow up to be) of the opposite gender. They prefer or demand, clothing, hairstyles, toys that are usually associated with the other gender and express their unhappiness with their physical sex characteristics.

However, this type of behavior is fairly and reasonably common in childhood and a part of growing up. It does not necessarily mean that all children behaving this way have gender dysphoria or other gender identity issues. While some children may exhibit behaviors and feelings relating to gender dysphoria at an early age, they may come to terms with their gender identity as they grow old and simply not be gender dysphoric. It is really tricky and difficult to determine gender dysphoria before puberty and adolescence.    
Gender Dysphoria in Adolescents and Adults

A small number of children might feel lasting severe distress and unease, which gets worse as they get older. This usually happens around puberty, where young adolescents might feel that their physical appearance does not match their gender identity. For some people, at the onset of puberty, they suddenly find themselves unable to identify with their own bodies. Gender dysphoria might start in childhood and continue into adolescence and adulthood. Adults are much more clear in their thoughts and feelings regarding their gender identity. 

Signs or Symptoms of Gender Dysphoria 
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults.
In adolescents and adults, gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:

• A marked incongruence between one’s inner gender and primary and/or secondary sex characteristics
• A strong desire to be rid of one’s primary and/or secondary sex characteristics
• A strong desire for 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 conviction that one has the typical feelings and reactions of the other gender

In children, gender dysphoria diagnosis involves at least six of the following and associated significant distress or impairment in function, lasting at least six months.
• A strong desire to be of the other gender or an insistence that one is the other gender
• A strong preference for wearing clothes typical of the opposite gender
• 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
• A strong rejection of toys, games, and activities typical of one’s assigned gender
• A strong dislike of one’s sexual anatomy
• A strong desire for the physical sex characteristics that match one’s experienced gender

Challenges and Complications 

Gender dysphoria can impair many aspects of life as a result of incongruence. Due to feelings of stress and stigma, people with gender dysphoria become socially isolated, contributing to low self-esteem, depression and anxiety, self-harm, eating disorders, substance abuse, or other problems. They might refuse to go to schools or workplace, due to pressure to dress and act in a certain way associated with their assigned sex, or out of fear of being harassed or mistreated.

Gender dysphoria is associated with high levels of stigmatization, discrimination, and victimization, leading to negative self-image and mental disorders. In some cases of gender dysphoria, the disturbance can be so pervasive and mentally draining that an individual’s mental health revolves around activities that deliberately lessen gender-related stress.

Relationships difficulties are common, like having impaired relations with family members or relatives that may hold negative or stigmatizing views about transgender or gender non-conforming individuals. The sense of being deeply misunderstood and not being able to truly express oneself persists. Suicidal ideation, suicidal attempts, and self-harm are relatively common among those experiencing gender dysphoria. People also experience discrimination, resulting in minority stress. Access to health services and mental health services can be difficult, due to fear of stigma or lack of experienced providers. Even after gender transition, depressive symptoms and suicide risk might persist, depending on the adjustment of individual.

How to Cope with Gender Dysphoria?

Treatment options for gender dysphoria include counseling, therapy, cross-sex hormones, puberty suppression, and gender reassignment surgery. Some adults might have a strong desire to be treated as a different gender without necessarily wanting to undergo medical treatment or alteration of their body. They may only want support and validation to feel comfortable in their gender identity. Others may seek medical help to completely transition to the opposite sex, including hormone treatment and gender reassignment surgery. Therapy can also help a person understand and explore their feelings and cope with distress and unease.

Psychotherapy is often very helpful in bringing about the personal discovery that facilitates self-comfort and acceptance. The level of stress for a gender dysphoric person is significant, and it is best for individuals to be in supportive environments, where they are allowed to freely express their gender identity in a way where they feel most comfortable, without the fear of judgment or prejudice. 

There is still a lot of misinformation, stigma, and prejudice relating to topics on transgender and gender dysphoria. Caitlyn Jenner once said in an emotional and sensational interview with ABC News, “ I’m me. I’m a person, and this is who I am. My brain is much more female than it is male. It’s hard for people to understand but that’s what my soul is.” Gender dysphoria isn’t a mental illness and shouldn’t be treated as such. People undergoing a gender identity crisis are just that, people. It is important to understand and accept them in the way that they are most comfortable with. Only then, we as a society can collectively flourish.

The least we do is be kind and supportive to people suffering from Gender Dysphoria. Educate yourselves and your peers and family that it's a normal and natural thing which shouldn't be considered as an abomination of nature.

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Written By- Radhika Rathi
Edited By- Kashish Chadha

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