Gender dysphoria, also known as gender incongruence, may be experienced by transgender individuals and others whose gender does not align with the gender they were assigned at birth. Some people may develop mental health concerns as a result of distress experienced with gender dysphoria, but this incongruence itself is not a mental health condition, just as being transgender is not a mental health condition.
Many—though not all—trans people experience dysphoria. Non-binary, agender, and other gender non-conforming individuals might also experience dysphoria, as may some intersex people. Anxiety, depression, stress, and feelings of isolation may develop in those who experience dysphoria, and a therapist or counselor can offer support to individuals coping with these and other concerns.
Gender dysphoria appears in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a revision of gender identity disorder. This revision was made in support of trans individuals seeking treatment or care options such as counseling, hormone treatments, gender confirmation surgery, and/or a legal name and gender change. Many of these options for transition can only be accessed by those who have a diagnosis. Some people feel including any diagnosis related to gender identity in the DSM falsely perpetuates a belief that the diagnosis indicates a mental health condition, but the American Psychiatric Association made the choice to maintain the entry to allow individuals continued access to care. The term "dysphoria" is believed to more accurately represent challenges faced in relation to a gender identity inconsistent with that assigned at birth, and thus, may help reduce stigma and barriers to treatment for trans people.
Once thought to be a psychiatric condition, gender incongruence is now widely recognized as a medical condition that is potentially rooted in biological factors such as prenatal development of gender identity. However, the cause of dysphoric feelings, as well as the reasons some experience it and some do not, has not yet been determined. The experience of dysphoria differs by individual, and distress is not necessarily part of the experience of all trans individuals. For many, feelings of dysphoria can be distressing or uncomfortable, but not all individuals who experience dysphoria will be negatively impacted. Gender dysphoria itself does not indicate or cause mental health concerns, just as being transgender does not. However, people who have dysphoria may develop depression, anxiety, or face other challenges to mental and emotional well-being, often as a result of societal judgment, stigma, transphobia, and/or harmful stereotypes. People may experience dysphoria regardless of their gender identity; that is, non-binary or gender-nonconforming individuals are equally likely to experience body or social dysphoria.
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Gender dysphoria is sometimes incorrectly associated with body dysmorphia, a condition associated with body image and anxiety, but the two are not related. People diagnosed with body dysmorphia usually experience persistent negative thoughts about what they feel are imperfections in their appearance, but these thoughts typically cause significant distress, often to the point where they interfere with daily life. Individuals diagnosed with body dysmorphia may seek to correct what they perceive to be flaws with surgery, but surgery is not considered a treatment for body dysmorphia, as it does not usually resolve the feelings of distress. Body dysmorphia is not related to gender identity.
Gender dysphoria may be experienced as body dysphoria, social dysphoria, or both. Body dysphoria may lead an individual to feel uncomfortable with the entire body or only with certain parts of the body. Some may feel as if they were born into the “wrong” body, but others may use different language to describe their personal experience. Because each person’s experience differs, no broad statement can describe how an individual may be affected by dysphoria.
Social dysphoria can describe distress and discomfort that occurs as a result of how one is viewed by society. Assuming a person’s gender, using incorrect pronouns, or making assumptions about social roles in relation to gender can all be factors contributing to a person’s experience of social dysphoria.
Individuals who are non-binary (people who do not identify as male or female) might experience both body and social dysphoria. Non-binary identities are often marginalized, ignored, or written off as "gender confusion." Some people may not even be aware of any gender identity other than male or female, and people who do not conform to societal expectations of gender may be stigmatized, misgendered (sometimes intentionally), and may face harassment. All of these can have a harmful impact and contribute to negative feelings, including dysphoria.
The term intersex describes the condition of having reproductive or sexual anatomy that does not align with what is typically described as female or male. A person's genitalia or secondary sex characteristics may be affected, but there may also be no outward sign that a person is intersex. An intersex condition may be noticed late in life, in adulthood, at birth, or may never be realized. In years past, when babies were born with intersex anatomy, doctors often performed surgery immediately to give the infant either male or female genitalia. Some doctors informed the parents and allowed them to make the choice, but some doctors performed these procedures without the parents' knowledge or consent. In either scenario, many children who were assigned a gender and then received surgery to physically align their bodies with that gender expressed a different gender identity later in life, and many of them experienced gender dysphoria.
Today, awareness of the harm this practice can cause is shifting the way intersex conditions are treated. Many doctors encourage parents to wait until children born with intersex are old enough to make an informed decision about surgery for themselves. Individuals who seek surgery on their own to align physical characteristics with their internal sense of gender may be less likely to experience dysphoria.
Many individuals first experience gender incongruence in childhood, but some may not have feelings of dysphoria until later in life. Children who express a gender identity different from the gender assigned at birth early in life may also have feelings of dysphoria at an early age. Some research has shown when these children are encouraged to live as their actual gender and are otherwise supported and accepted, they may be less likely to experience anxiety and depression and may experience greater emotional and mental well-being overall than those who are not supported.
People might develop feelings of dysphoria when they first realize their physical characteristics do not align with their gender, but they may also not experience feelings of dysphoria until later in life, if at all. Many individuals seek the help of a therapist when they first experience these feelings, but many more are not able to seek professional care, for any number of reasons. The lack of access to care may contributed to worsened feelings of dysphoria and may have an impact on mental and emotional well-being. .
A person may continue to experience dysphoric feelings for months or even years. Some may be significantly impacted by dysphoria, but for others, the distressing feelings may only rarely surface. For many, outwardly expressing their actual gender helps address the sense of gender incongruence and may reduce dysphoric feelings. There is no specific treatment for gender dysphoria, but those experiencing distressing feelings typically can take a number of steps to address them.
Many work through feelings of dysphoria with the help of a trained therapist or counselor. Individuals who wish to take hormones and/or pursue surgery to better align physical characteristics with their gender may find feelings of dysphoria begin to ease as they take these steps. Some may simply live as their true gender without hormones or surgery. Many individuals legally change their name and gender marker to reflect their true gender, and for many individuals, it may be the case that being socially recognized as a member of their actual gender and being addressed by the correct pronouns helps to ease feelings of dysphoria.
People might develop feelings of dysphoria when they first realize their physical characteristics do not align with their gender, but they may also not experience feelings of dysphoria until later in life, if at all.Regardless of the stage a person is at in transition or whether or not a person transitions at all, gender dysphoria may still persist, and talking through any negative or distressing feelings with a therapist or counselor may be beneficial to many. Family acceptance and peer support can also have a positive impact. In general, greater awareness and social acceptance of trans and non-binary identities may help make the experience of social dysphoria less likely for many.
It is important to note gender dysphoria is not linked to low self-esteem. People with gender dysphoria may experience low self-esteem, like anyone else, but encouraging individuals to love their body or have more self-confidence or otherwise attempting to treat low self-esteem will not resolve feelings of distress related to gender dysphoria and may have a negative impact. Individuals who seek therapeutic treatment may wish to find a therapist who specializes in the treatment of gender dypshoria.
When individuals with gender dysphoria also experience depression, anxiety, or other concerns, a therapist will treat these also. Some individuals may be referred to a psychiatrist for medication to treat these conditions, or they may continue in therapy for treatment of other concerns even if they do not continue to experience gender dysphoria.
Many individuals who experience gender dysphoria do not have access to any sort of counseling or medical care. Every person should have access to care and all treatment options, whether they choose to pursue any manner of treatment or not. Increased awareness of transgender and non-binary identities, people who are intersex, and the challenges they may face is likely to be a helpful step in greater recognition of gender dysphoria and an increase in access to compassionate medical and mental health care.
- Exploring others' reactions to genderqueer identity in therapy: Ash, 24, enters therapy reporting feelings of anxiety and high levels of stress. They tell the therapist they are genderqueer and have recently begun using the pronoun "they" to reflect their identity. A number of Ash's friends were immediately supportive and began to use the correct pronoun upon being told, but other people in Ash's life, including acquaintances and family members, were not as supportive. Ash tells the therapist they were assigned female at birth but never felt comfortable identifying as female, nor did they ever feel as if they were male. Not having a defined gender feels right, Ash says, and they are comfortable with their identity but experience distress because other people are not comfortable. Ash reports being told, "Of course you're a girl! You wear dresses and have long hair" and "You just want to be different from everyone else." But, they tell the therapist, being called a girl causes intense discomfort, as does menstruation and the size of their chest. The thought of going out in public leads Ash to experience anxiety out of a fear of being misgendered, and many daily interactions have become so stressful Ash has come to dread getting out of bed. Ash also reports a general lowness of mood that comes and goes, depending on day-to-day interactions with others. Ash expresses the intent to have top surgery to feel more comfortable in their body and discusses with the therapist possible options to stop menstruation to reduce period-related dysphoria. In sessions, Ash and the therapist also discuss methods of having a productive conversation about gender with the people in their life who are less than accepting of gender nonconformity and explore ways Ash might relieve some of the anxiety and dread of public interactions.
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