What do we know about Gender and Dysphoria?

‘Gender dysphoria’ refers to the distress experienced by an individual when there is a mismatch between their gender identity and their sex assigned at birth. One is assigned their sex based on anatomy. For most people, their gender identity corresponds with their assigned sex and such individuals grow without experiencing the distress of “feeling out of place in one’s own body.” For some, however, the difference between their gender identity and assigned sex causes extreme confusion and turmoil. Typically occurring in (but not all) transgender and gender-nonconforming individuals, this can lead to them undergoing sex reassignment surgeries, hormone replacement therapy, as well as psychotherapy to cope with the distress.  

Previously termed "gender identity disorder," gender dysphoria is defined as a “marked incongruence between their experienced or expressed gender and the one they were assigned at birth,” according to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5).

The American Psychological Association explains that gender dysphoria is diagnosed if characteristics including a strong desire to be treated as a gender other than the assigned gender and/or a strong desire to be rid of one’s sexual characteristics are seen, in addition to experiencing clinically significant distress associated with the condition. 

While standalone causes have not been identified, in a paper titled Gender Dysphoria (Sexual Identity Disorders) by Garima Garg Ghada, Elshimy and Raman Marwaha published on the National Center for Biotechnology Information identifies gender dysphoria to be caused or influenced by biopsychosocial factors and some level of genetic influences. Like sexual orientation, gender is not a choice. Social and cultural norms that frown upon effeminate males and masculine-presenting females, especially when children are around the ages of 3-5, in their interactions with people at home and outside, piece together concepts of gender. This might add to the distress in young adults when in the process of figuring their gender identities.

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Related distress is often intensified by the associated stigma present in society. Adolescents and adults who experience this turmoil cannot relate to their gender expression within traditional male or female roles, which causes further stigmatization. This leads to relationship conflicts and can even lead to extreme social exclusion.

The most impacting of them all is perhaps the internal conflict experienced. The inability to be able to relate to the normalised gender binary causes an increase in the symptoms of depression, anxiety, and substance abuse in these individuals. They are subjected to mistreatment and neglect, often becoming victims of physical and sexual abuse. There also exists poor or complete lack of self-esteem, along with a risk of self-harm and suicidal ideation.

Some adults may desire to be treated as a different gender, without seeking medical treatment or physical alterations. This may stem from the need for support to feel comfortable with their identity in society. Others may want more extensive treatments, including hormone treatment and/or gender reassignment surgery.

Therapy can help a person understand and explore their feelings and cope with distress and conflict. When provided to family members, therapy may help create a supportive environment. 

Treatment in children focuses primarily on affirming psychological support, understanding emotions and coping with distress. 

Awareness

In these distressing times, people experiencing dysphoria may find themselves in unsafe spaces, forced to reside with families or in communities that might be harmful to them. This further aggravates their trauma. As a society, there is so much we can and must do to help. We need to do away with myths commonly associated with the term ‘gender’ - one, that gender is the same as sex; and two, that gender is binary.

In simple terms, sex is the label assigned by the doctor based on chromosomes and genitalia, whereas gender is a sex-based social structure - how one is expected to think, behave, and act based on their sex. NOT interchangeable with biological sex, just happens to be based on that thanks to society and its norms. Even defining biological sex in binary terms is harmful as it leads to intersex-erasure - invalidating the lived experiences of a whole group of people whose biology is such that they fall out of the binary.

Gender identity and expression are, while confused as interchangeable, not the same; gender identity is how someone views themselves (male/female/transgender/genderqueer/bigender/agender/etc.) and expression is how one wishes to express oneself in terms of practices, likes and dislikes, clothing and accessories, mannerisms and interests in that social context (masculine/feminine/androgynous etc.). For example, one can identify as male and express himself as androgynous or identify as non-binary and express themselves in a traditionally feminine manner - however they like.

This non-conforming of the gender binary in terms of identity is often termed non-binary, where one's identity may be in between or fluctuate between different identities or simply exist outside the binary. This is also sometimes called genderqueer, genderfluid, or gender-neutral. While this doesn't mean that all these terms are exactly the same, they do have similarities and overlap sometimes.

In terms of expression, this is termed gender nonconformity. What this means is one chooses not to adhere to (often oppressive) heteronormative norms that reinforce gender roles. Both identity and expression are personal and unique to an individual and do not have to adhere or conform to any binary norms that anyone else creates. All labels can and should be decided by one for themselves, nobody else can thrust these labels on anyone.

While we are on the topic, we might as well think about sexualities and how they aren't dependant on one's gender identity or sex. One's sexual orientation does not determine their gender identity or vice versa. One's biological sex does not determine who one is sexually or romantically attracted to. As the labels that describe these relationships are on the basis of gender and the gender types one is attracted to, many people are in favour of entirely ditching the concepts of labels while terming their sexualities and preferences and preferring to refer to themselves simply as queer.

Gender, like sexual orientation, is a continuum, a spectrum not limited to male or female terms. This awareness is essential in better understanding and enabling a more receptive and responsive society.