Gender Dysphoria: A mental disorder?

 

The world today is showing acceptance towards people with different gender identities, be it by participating in  pride parades or having LGBTQ+ friendly restaurants and bars. But there are still people who find it uncomfortable to discuss it or even try to understand it. It is important to consider ‘humans’ as ‘humans’ and not categorise them according to their gender identity or sexual orientation. One such topic which is not much talked about is ‘GENDER DYSPHORIA’.

 Gender Dysphoria was previously termed a Gender Identity Disorder. It is not necessary that all transgender individuals have Gender Dysphoria. Gender Dysphoria is the feeling of distress and discomfort that an individual feels due to the difference between their biological sex and gender identity. It may include a strong desire to change one’s primary and secondary sexual characteristics. For example, an individual who was assigned the female sex at birth may want to be treated and referred to as a male. While some individuals understand that they have Gender Dysphoria in childhood, others may recognise it at the onset of their puberty or even later. According to the DSM-5-TR (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision); Gender Dysphoria occurs in an individual when he/she/ they has/ have felt discomfort between their assigned gender and expressed gender for at least 6 months. 

People with gender nonconformity face high levels of discrimination and stigmatisation which often leads to mental trauma. Gender nonconformity also leads to victimisation and abuse in certain social places. The suicide rat in the transgender community ranges from 32% to 50% across different countries. People sometimes feel trapped inside their own bodies because they are unable to connect with themselves physically. They also have a hard time connecting with other people. In various countries including India, the family of the individual, too has a hard time digesting the gender nonconformity of their children; and in a worst-case scenario they cut their contacts with them and abandon them. This often leads to fear of abandonment; affects their ability to form relationships with other people and sometimes also harms their existing relationships. Studies indicate that people with gender dysphoria have increased rates of depression and anxiety. Although a reduced number of studies have been performed in the clinical population with Gender Dysphoria, there is  a study indicating that Social Anxiety Disorder was the most prevalent anxiety disorder, reaching 9.1% (trans male 11.3% and 8.2% trans female) in the Gender Dysphoria Spanish population (Bergero-Miguel et al., 2016). The Australian Trans Pathways study (2020) in youth (14–25 years) has likewise reported high levels of distress, expressed in high rates of self-harm (79.7%), suicidal thoughts (82.4%), and attempted suicide (48.1%), and in substantial psychological comorbidities (depression [74.6%], anxiety [72.2%], post traumatic stress disorder [25.1%], personality disorders [20.1%], and psychosis [16.2%]) (Strauss et al; 2020). Their mental health has an adverse effect on their career and on their cognitive and physical abilities.

While there are people who try  and support these individuals, there are also people who believe in doing otherwise. Transphobia is  having negative emotions and attitudes towards transgenders and people with gender nonconformity (What’s Transphobia and Transmisia?, n.d.). Since using the word phobia is inappropriate for the people who have actual phobias that result in anxiety, the word transphobia is replaced by ‘transmisia’, wherein the word ‘misia’ means hatred. This may include the media stereotypically portraying trans individuals as evil, fake or even dangerous; or setting up norms that prevent them from participating in activities like community health care or even sports. It involves people neglecting their different gender identities and even denying their existence. Outing someone without their consent in front of others is also a factor of transmisia because the person who intentionally outs someone has no regard for their feelings and does not respect them. Transmisia takes a toll on the mental health of the people of the trans community, be it a joke or a harsh comment or an act of hatred. If someone has unintentionally crossed their line and hurt their emotions, it is necessary to not justify those actions or make any excuses but rather apologise for them instantly. Combating transmisia is not difficult. People need to educate themselves on transgender community; their rights, their identities and how to respect them. Prefer to not ask them questions about their genitals or make any backhanded comments and ask for the pronouns that they would like to be called by instead of making assumptions

Just like transmisia, gender dysphoria can also be dealt with. Treatment helps people understand the gender role that is comfortable for them. However these treatments are subjective in nature and do not have the same effect on everyone. Under the medical treatment aspect, an individual can undergo hormone therapy or surgery where one seeks for complete masculinization or feminisation of their hormones, genitals and other physical characteristics. Under the behavioural aspect, the individual undergoes therapy where they learn to accept their gender and try to be comfortable with their gender in public. One can also be part of peer support groups and be part of various social services groups. 

There are also various studies conducted on how ASD (Autism Spectrum Disorder) overlaps with Gender Dysphoria. Transgender and gender-diverse individuals were 3.03 to 6.36 times as likely to be autistic than were cisgender individuals, after controlling for age and educational attainment; these individuals scored significantly higher on self-report measures of autistic traits, systemizing and sensory sensitivity and scored significantly lower on empathy traits compared to cisgender individuals; these individuals had elevated rates of multiple other neurodevelopmental and psychiatric conditions. Finally, exploratory analysis identified that transgender and gender-diverse individuals were more likely to report that they suspected they had undiagnosed autism (NCBI - WWW Error Blocked Diagnostic, n.d.). 

Gender Dysphoria is therefore a disorder that should not be neglected. It is vital to be aware of it and act accordingly towards people with Gender Dysphoria and help them in whatever ways you can because at the end of the day, the focus should be on what makes us more humane rather than the labels we humans put on.  

REFERENCES

1. NCBI - WWW Error Blocked Diagnostic. (n.d.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415151/

2. Just a moment. . . (n.d.-b). https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

3. Bergero-Miguel, T., García-Encinas, M. A., Villena-Jimena, A., Pérez-Costillas, L., Sánchez-Álvarez, N., de Diego-Otero, Y., & Guzman-Parra, J. (2016). Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain. The Journal of Sexual Medicine, 13(8), 1270–1278. https://doi.org/10.1016/j.jsxm.2016.05.009

4. Just a moment. . . (n.d.). https://journals.sagepub.com/doi/abs/10.1177/26344041211010777

About the Author 

The author is Hrishika Jain, studying in B.Sc. Applied Psychology. Being a psychologist has always been her ‘dream-career’ and to be able to pursue it makes her feel content. She loves reading and books have always been her happy place. She is an introvert and writing is her way of expressing thoughts. Mountains and Music are the 2 ‘M’s’ that make her feel calm.