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Posts tagged ‘gender dysphoria’

Sexual and Gender Identity Disorders | APA’s proposed changes (part 2) – DSM-5

The previous post with the first version of the proposed changes can be found here.

A few notes before the quoted text.

  • The big changes from the last revision (not from the last DSM) are that

1. they’ve dropped ‘gender incongruence’ and gone with ‘gender dysphoria’

2. they have added a ‘B’ criteria of distress and

3. they have added a ‘post-transition’ specifier.

  • Version 5 of the book is due out May 2013
  • the current commenting period will end on June 15, 2011.
  • This is the APA DSM 5 (American Psychiatric Association) site.  The APA “writes” the DSM (Diagnostic and Statistical Manual)
  • It’s important because this will be one of the key tools for how mental health professions view and define gender issues for the coming decade.

The following (in blue) is quoted from the APA site:

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Updated May 4, 2011

 Gender Dysphoria (in Adolescents or Adults)**

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators: [2, 3, 4]**

1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]

2. a strong desire to be rid of one’s primary and/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) [17]

3. a strong desire for the primary and/or secondary sex characteristics of the other gender

4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning,  or with a significantly increased risk of suffering, such as distress or disability** 

Subtypes

With a disorder of sex development [14]

Without a disorder of sex development

See also: [15, 16, 19]

Specifier**

Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).

Note: Three changes have been made since the initial website launch in February 2010: the name of the diagnosis, the addition of the B criterion, and the addition of a specifier. Definitions and criterion under A remain unchanged.

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Understanding Gender Dysphoria

While there are many social implications related to gender dysphoria that I’ve written about and will write about in the future this post focuses on the inner experience of gender dysphoria.

Gender Dysphoria is a fundamental unease and dissatisfaction with the biological sex one is born with (one’s body) which results in anxiety, depression, restlessness, and other symptoms.  The dysphoria often acts as a catalyst to change one’s body and gender expression (how one presents to the world) to be more in keeping with what is felt to be one’s gender identity (the gender that one feels oneself to be).

In simpler terms this means that natal (biological) males, who are gender dysphoric have unease, dissatisfaction and even disgust with their male genitals, body hair, angularity, facial hair, musculature and any other attributes that one typically identifies with “maleness”.  Natal females who are gender dysphoric can have similar feelings with developing breasts, fuller hips, long hair, menstruation and other attributes that are associates with femaleness.

The time of adolescence when sex changes become more pronounced is understandably a very difficult time for many transgender individuals.  Puberty blocking interventions are now becoming more common in dealing with this.

It can be difficult for people to express how one feels about one’s body, in part because people with gender dysphoria often wish to avoid of the whole subject.  I’ve heard many variations of “it just feels wrong” or “I don’t like it”.   The following is an excerpt from Dear Sir or Madam: The Autobiography of a Female-to-Male Transsexual (1996) by Mark Rees:

 One of the great battles was of The Bra.  I angrily spurned the bra which my mother bought me when I was fourteen.  To have worn it would be not only accepting my femininity, but accentuating it.  I could do neither.

I’ve seen that transgender individuals vary in the degree to which they are disturbed by their male or female organs.  Some will be extremely avoidant of them; not looking in a mirror, not going to the doctor, not going to the beach or pool so as to avoid putting on a bathing suit and not have sexual partners, etc.  Others can engage in these activities to some extent but may still feel uncomfortable.

For many transgender individuals being transgender is not just about wanting to live in the social role of the other gender (to some degree), but it’s also about a fundamental dissatisfaction with one’s body.

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you. email: info@amikaplan.net

Book Review: “Helping Your Transgender Teen: A Guide for Parents”

Irwin Krieger, a Connecticut Psychotherapist and gender specialist has written a 75 page guide for parents of trans teens (2011, Genderwise Press, New Haven, CT. ISBN: 069201229X).
The book provides a good “lay of the land” for parents who have little information about what it means to have a transgender child. It includes a glossary of terms, a primer on gender and sexuality, and a fairly detailed roadmap for what to expect should the teen decide to transition.

It is particularly strong in articulating the tensions that can arise between an impatient teen and a cautious parent who is trying to “come up to speed”. Other helpful areas are sample letters to extended family members explaining the situation, thoughts on what to expect when a teen transitions at school and a discussion of the typical fears a parent may have.

There are few minor points with which I took issue – namely a tendency (not just here but in a good deal of transgender literature) to paint the (FTM) female to male transgender child’s experience as somehow “easier” and Krieger’s describing a teen’s coming out as gay as often being a “transitional identity” to what may later be a “straight” identity. This may overlook the strong “queer” identity that many young people lay claim to before, during and even after transition.

These points aside, “Helping Your Transgender Teen” is sure to do just that for a good many parents who will be reassured and educated by this book.

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