Cases of gender dysphoria are tested quite often. People complain about this pathology, confident that nature “made a mistake” in determining his physiological gender. People who actually suffer from this pathology are deeply unhappy. The realization of one's desires in accordance with one's perceived gender is in most cases condemned by society. This causes problems with socialization, creating a family, and self-determination. Confirmed gender dysphoria is quite rare.
Regardless of the imaginary confidence in the presence of a “mistake” of nature or the presence of a real diagnosis, pathology requires treatment by a psychotherapist. Confirmation of the diagnosis requires a thorough medical examination. An important task for the physician is to determine what the patient is suffering from. Gender dysphoria or homosexuality. Delusions of gender reassignment may occur in schizophrenia.
Gender dysphoria in a teenager
Diagnosing gender dysphoria in adolescents requires maximum attention when confirming the diagnosis. When conducting the survey, the following factors are taken into account:
- the desire to choose clothes of the opposite sex;
- repeated statements about belonging to a different gender;
- participation in activities and games that are characteristic of the opposite sex;
- preference for roles of the opposite sex in fantasies and games;
- choosing children of the opposite sex as play partners.
Research shows that about three-quarters of adolescents who were suspected of having a pathology in childhood retain their original gender orientation, but declare their own homosexuality or bisexuality. This comes with the risk of early diagnosis. Accurate confirmation is carried out only after reaching adulthood while maintaining a sense of belonging to the other gender. At an early age, manifestations may be associated with characteristics of socialization in society. Adolescents are often in a state of gender identity disorder associated with the characteristics of the transition period.
Reasons for development
The immediate cause of the experience is the discrepancy between internal sensations and external reality. A person who was recorded as a man at birth and has the corresponding anatomical features feels like a woman and vice versa.
The severity varies significantly. Some people only sometimes see themselves as members of the opposite sex. Others categorically do not accept their gender status, undergo hormonal treatment, undergo surgical interventions to change sexual characteristics, and then change their passport data.
The mechanism of formation has not been precisely established. Currently, the dominant theory is that an altered perception of one's gender is established in the prenatal period. Studies have been published indicating differences between the brains of cisgender people and transgender people, however, it has not yet been possible to systematize the differences and explain the nature of the discrepancy between psychological and biological sex.
When determining the question “disease or not,” modern experts speak out unequivocally. Sex and gender discrepancy is not a disease. Gender dysphoria causes suffering and is therefore considered a disease and requires treatment.
Gender dysphoria in adults
Adults usually already clearly understand their gender identity. Often they choose the life sex of a member of the other sex, changing their job, environment, habits. Factors taken into account during diagnosis in childhood remain the same. An exclusion of homosexuality or bisexuality is required for confirmation. A test is being carried out for schizophrenic mania. Within the framework of psychoses, ideas about one’s own gender identity take a manic form. People who are characterized by inconsistency due to the presence of a disorder demonstrate their actions consistently and not manically.
Social gender
Despite the biological origin, a person exists within a society in which he develops according to a certain model of behavior and is perceived by society accordingly - as a man or a woman. Such a system is called a social role. It is formed in the process of personality education and includes psychological differences between two characteristics.
A person occupying a certain social status is somehow seen as a representative of a particular gender. However, it is no longer biological, but social. In modern terminology, the concept of gender is used for such a situation.
Symptoms and signs of gender dysphoria
The first manifestations are noticeable already in childhood. Those people who may require gender reassignment in the future have noticeable characteristics:
- from the first years they refuse the clothes and behavior patterns characteristic of their physiological sex;
- there is a refusal of the physiological response to physiological needs, for example, girls may try to write from a standing position;
- attempts to confirm one’s belonging to the other sex are persistent;
- The manifestation of gender characteristics in adolescence becomes a tragedy.
Signs may not appear in childhood, but show their presence already in adulthood.
Biological sex
From a biological point of view, a person belongs to the order of primates of the hominid genus (apes, humans and their extinct ancestors), as a result of which he is a representative of one of three types of sex:
- Female - consists of two X chromosomes.
- Male - consists of two different chromosomes, types X and Y.
- Intersex, i.e. chromosomes deviated from the norm and including characteristics of both sexes indicated above. They are also called hermaphrodites.
Everyone knows what distinguishes man as a biological being from his younger relatives:
- presence of consciousness, thinking and speech;
- labor (production of tools);
- the need for spiritual and moral development.
However, homo sapiens is not only a biological, but also a social subject, capable of going against the iron laws of nature.
Psychotherapy (Gender Dysphoria)
Recent studies have confirmed that gender dysphoria is a disorder of intrauterine development, and not a psychiatric pathology. For this reason, people suffering from their own inconsistency with external gender characteristics are now recommended to consult a psychotherapist. But it is required not to choose a course of treatment, but to conduct consultation on self-identification. It is not always easy for people to accept their own differences from those around them. Often a negative attitude towards gender can be observed in a family that is not ready to accept a son instead of a daughter and a daughter instead of a son. Individual and group classes allow you to understand and accept the naturalness of the process of returning to your own gender without depression and unnecessary shock. Lack of treatment can lead to depressive conditions. Such people, in the throes of self-determination, sometimes think about ending their lives.
PsyAndNeuro.ru
According to Russian psychiatrists, changes in the medical and social paradigm regarding transsexualism, which are proposed in connection with the development of a new classification of mental disorders, practically eliminate the role of biological and mental factors that can contribute to its formation, and shift the emphasis from clinical assessment each case to a socially oriented normocentric approach. The authors present their reasoning in a review on gender identity published in the journal Consortium Psychiatricum.
According to them, the clinical manifestations of gender identity disorder (GID) are heterogeneous. They may be congenital and relatively stable conditions, developing in parallel with psychosexual maturation, or arising at some point in life. GID can manifest itself in the form of reverse identification (identification inversely proportional to gender) and non-binary identification (identification that goes beyond the binary gender role model). Some patients reject external signs of gender and want to get rid of them, others do not experience significant discomfort.
A major factor in determining treatment options for psychological and psychiatric support is gender dysphoria. It is a condition caused by rejection of one's biological sex and gender role status. It can be endopsychic or exopsychic. Endopsychic gender dysphoria is expressed in acute emotional experiences such as depression and anxiety. Exopsychic – in behavioral disorders, including addiction, self-destruction, self-isolation, and a tendency to conflict.
An overwhelming amount of research shows that people with GID have a high prevalence of mental health disorders, including a high risk of suicide. The article provides data on the tendency of children with gender role violations to self-stigma, depression, eating disorders, alcoholism, drug addiction, and in some cases, self-harm and suicidal behavior. The authors separately highlight schizophrenia spectrum disorders, which often occur with gender role disorders.
Changes in the medical and social paradigm have led to the fact that gender identity is considered as a consequence of upbringing, the influence of stereotypes of gender role behavior accepted in the macro- and microsocial environment, and the choice of the individual. This has significantly expanded the boundaries of acceptability regarding gender role behavior. The authors of the article note that within the framework of gender theory, the mechanisms of GID are inconsistently explained. On the one hand, the new concept does not deny the results of research into the biological nature of GID. On the other hand, it affirms the freedom of gender positioning for all people. Proclaiming absolute freedom to choose a model of gender-role behavior, the new approach devalues the motives for this behavior and combines all GID options into the group of transgender people. In this case, along with transsexuals, they include people with transvestism, some homosexuals and nonconformists. According to this theory, attempts to study factors of predisposition to “transness” become pointless.
In accordance with the new paradigm, approaches to diagnosing GID have also changed. According to the official WHO position, gender identity in itself is not the subject of psychiatric analysis and should be considered in the context of civil liberties and individual psychological manifestations.
The scientific validity of the changes that have occurred raises doubts among Russian experts. In their opinion, gender identity is a complex mental construct that is determined by biological and social effects, including congenital and acquired, as well as stable and variable parameters, such as features of the cultural environment, professional, linguistic aspects, material and living conditions. Russian scientists consider gender identity and physical gender characteristics to be biologically determined. And the new concept actually excludes the role of mental and biological factors in the formation of gender identity.
Working with people who express a desire to change their gender requires a differentiated, yet ideologically neutral approach. Such patients require careful clinical diagnosis to exclude a mental disorder. According to the authors, the further development of psychiatry should be associated, first of all, with the destigmatization of mental disorders, and not with the depathologization of their individual manifestations.
Authors: Anton Dyachenko, Alexey Perekhov, Viktor Soldatkin, Olga Bukhanovskaya
Source: https://www.consortium-psy.com/jour/article/view/68
For citation: Dyachenko AV, Perekhov AY, Soldatkin VA, Bukhanovskaya OA. Gender Identity Disorders: Current Medical and Social Paradigm and the ICD-11 Innovations. Consortium Psychiatricum
. 2021;2(2):54-64. doi: 10.17816/CP68
Lack of treatment and its consequences
For many people with normal gender identification, questions about gender reassignment surgery cause genuine bewilderment, and the phenomenon of gender dysphoria itself is perceived as some kind of quirk. In fact, transsexuality is by no means a fad, and gender reassignment is the only possible solution. After all, as already mentioned, the discrepancy between gender and consciousness affects the mental state of a person. For example, denial of the problem, lack of understanding among others and the inability to get rid of one’s own thoughts and desires cause constant emotional discomfort, suffering and pain, which often leads to clinical depression, drug or alcohol addiction, and the development of suicidal tendencies.
Does everyone need gender reassignment surgery?
Quite often, the only way to improve a person’s life is gender reassignment surgery. With this type of surgery, women undergo removal of the uterus, and male genital organs are reproduced from the patient’s own tissues and special implants. Men, on the contrary, are spared the external genitalia, forming a female vagina from their own tissues.
Of course, before going to the surgeon’s table, the patient undergoes a lot of research, since doctors must first make sure whether gender dysphoria really occurs and whether the person can cope with the consequences of the operation. For example, there are some standard requirements for patients. To begin with, it is worth noting that they all must be adults. In addition, a person wishing to change gender must undergo a series of psychological tests, which make it possible to determine the absence of mental illness.
Gender reassignment helps a person create balance between the different facets of their personality. In turn, this gives the patient a feeling of wholeness, happiness and harmony.
Benjamin Gender Identity Scale
The gender dysphoria test is associated with the name of the American doctor Harry Benjamin. He was the first to try to classify forms of gender-variant behavior. His attempt was to create a scale of 6 categories:
- Pseudo-transvestism.
- Fetishistic transvestism.
- True transvestism.
- Non-op transsexualism.
- Nuclear transsexualism with moderate gender dysphoria.
- Nuclear transsexualism with a severe degree of disorder.
However, current views do not correspond to the vision of a specialist. Sexual orientation is not considered as a criterion for distinguishing between transsexuality and transvestism.
Until now, there is confusion in these concepts, which should be dispelled.
Transvestism is a psychological phenomenon in which there is a desire to transform into a person of the opposite sex by dressing up and acquiring accessories characteristic of that sex.
Transvestism is not always the same as transsexualism. It is men who most often represent this phenomenon, and they have no desire to adjust their biological sex. When a person does not feel discomfort with his body and satisfies sexual needs with the help of dressing, we are not talking about gender dysphoria.
The most effective way of testing is to make an appointment with a psychotherapist who will help you sort out your identity if any doubts arise.
Symptoms
The main symptoms of gender dysphoria are clear:
- Unconscious perception of oneself as a person of the opposite sex from early childhood. But it’s worth noting right away that not all transgender people experience this from an early age in their lives. Often awareness comes in adolescence, when the body begins to develop according to one or another sexual physiology.
- Reluctance to live in the gender role assigned to him from birth and expected by society in later life. In childhood, the situation manifests itself in the refusal to wear feminine (if it is a girl) and masculine (if it is a boy) things. The child has an involuntary desire to play with toys uncharacteristic of his biological sex in the company of the same children, to whom he unconsciously identifies himself.
- During puberty, hostility towards one's genitals and changes in the body becomes especially acute. It is during this period that gender dysphoria most often strikes with a nuclear strike. A teenager is unable to control physiological development and change the process in the opposite direction. A young transgender person is not accepted by society the way he identifies and cannot find a place for himself in a society with traditional values. Trans people are subject to both psychological and physical pressure from the outside, which clearly affects their internal state.
The main sign of gender dysphoria is the belief that oneself belongs to a person of the opposite sex and the inconsistency with this in real life.
All of the above points in most cases worsen over time and ultimately lead to death. Transsexuals become unable to withstand both the internal struggle with themselves and the external struggle with a merciless society, and therefore decide on the most desperate way out of the situation - suicide.
To avoid death, the causes of gender dysphoria must be eliminated by providing mandatory assistance - gender reassignment.
