What is gender dysphoria? Symptoms and mental health impact

What Is Gender Dysphoria? What Is the Difference Between Sex and Gender?

Gender dysphoria is characterized by experiencing distress and extreme discomfort due to feeling like the sex one is assigned at birth does not match, or is incongruent with, their experience of gender. 

Understanding the difference between sex and gender is key to understanding gender dysphoria. Sex is a biological construct, based on characteristics like anatomy, physiology, and hormones. Gender is a social construct, meaning it exists because humans have developed it as an idea over time. Cultural expectations, gender roles and norms all influence how society perceives people of a particular gender should think, act, and express themselves. 

In many Western cultures, gender is considered a binary by general society, with specific traits and ideas associated with each. This might include stereotypes like “men should be strong” or “women should be caregivers”. Because society tends to assume that there are just two ways to express gender and that one’s gender expression must be tied to their birth-assigned sex, almost all people have an assumed gender assigned to them from birth. 

This can cause people who experience gender differently from their biological sex to struggle with how to be themselves. This experience is often where gender dysphoria originates: the idea that one’s physical traits or gender expression do not match who they truly are. Those experiencing gender dysphoria often feel distressed about their current gender expression.

Gender identity can be experienced as a spectrum, with people landing in many places along it—from cis-gender (feeling that gender is aligned with assigned sex at birth) to non-binary (not solely identifying with either masculine or feminine gender expressions) or transgender (identifying as a different gender than what was assigned at birth).

Though physical traits and body image can contribute to feelings of gender dysphoria, it is not always a factor. Gender dysphoria is specifically about gender expression, which involves both physical traits and expressing oneself through clothes, hair, makeup, and more—how one presents themself to the world, and in-turn, how they are perceived by others.

Who Experiences Gender Dysphoria?

Anyone can experience gender dysphoria. However, just because you feel an incongruence between your assigned gender and the way you experience gender doesn’t mean you feel dysphoric about your gender. “Dysphoria” is an intense feeling of distress, unhappiness, or uneasiness. This means that gender dysphoria only occurs when one’s assigned gender feels incongruent with their experienced gender and they are extremely unhappy with or distressed about that incongruence. 

This can be because they don’t feel safe enough to express themselves as they would choose, they have been taught that expressing themselves in that way is wrong, or a number of other reasons.

Gender dysphoria is also tied to the expressed desire to be a different gender than what one was assigned or is currently presenting as—whether that’s tied to sexual identity or not. Dressing outside of one’s gender norms or expectations does not specifically indicate gender dysphoria.

Diagnostic Criteria for Gender Dysphoria

The DSM-5’s diagnostic criteria for gender dysphoria is split by age. For those over 13 years old, one must experience two or more of the following symptoms for at least six months:

• A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics 
• 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
• A strong desire for the primary and/or secondary sex characteristics of the other gender (or some alternative gender different from one’s designated gender)
• A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)
• A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)
• A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)

Children under 13 have similar criteria, but they must exhibit six of the following symptoms over the course of six months, specifically including the first symptom listed: 

• A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s designated gender)
• A strong preference for wearing clothes typical of the opposite gender (or some alternative gender different from one’s designated gender)
• A strong preference for cross-gender roles in make-believe play or fantasy play
• A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender
• A strong preference for playmates of the other gender
• A strong rejection of toys, games, and activities typical of one’s assigned gender
• A strong dislike of one’s sexual anatomy
• A strong desire for the physical sex characteristics that match one’s experienced gender

Another important note is that these symptoms must also be coupled with clinically significant levels of distress and impairment.

What Impact Can Gender Dysphoria Have on Mental Health?

The impact of gender dysphoria can depend on the society or culture one lives in, but at its worst, the effects can be devastating to a person’s mental health. Possible outcomes include: 

• Suicidality 
• Anxiety
• Depression
• PTSD (due to bullying, threats, hate crimes)

One of the communities most negatively impacted by gender dysphoria and society’s insistence on a gender binary is the transgender community. In areas like physical healthcare, mental healthcare, education, and more, transgender individuals are disproportionately underserved.

What Is the Difference Between Body Dysmorphia and Gender Dysphoria?

Though they can often be confused, the main difference between gender dysphoria and body dysmorphia is that body dysmorphia is not centered around gender, but is rather a discomfort with one’s current body and physical traits. Those with body dysmorphia see flaws with their body that may seem slight to other people, but cause them to feel undue amounts of self-criticism and distress.

Body dysmorphia is more about disliking how one looks, focusing on certain body parts and what is societally “good-looking” rather than gender-specific traits, and can be caused by issues with weight, acne, the look of certain body parts, and their alignment with what someone thinks they should look like. This condition can also be comorbid with eating disorders, though not always.

Gender dysphoria, on the other hand, is centered solely around one’s gender incongruence. One can experience both gender dysphoria and body dysmorphia at the same time, but just because someone has gender dysphoria does not mean that they will meet the criteria for body dysmorphia.

How to Support People Experiencing Gender Dysphoria

There are many ways to find support for those experiencing gender dysphoria. Commonly used resources include:

• Therapy: Talking to a mental health professional about your symptoms and how you’re feeling can be a great source of support for people with gender dysphoria. They can assess your symptoms, discern whether you might have any co-occurring conditions, validate your lived experiences, create an individualized treatment plan for you, and more.
• Support groups: Support groups can be an excellent place to find community, belonging, and support, as it’s important to see that you are not alone in your struggles and experiences. They can also be a great way to connect with your local LGBTQIA+ community, including others who have or are experiencing gender dysphoria. By forming connections with people you have common experiences with, you can start to feel more understood and validated in your experience. 
• Consuming supportive media: Make sure your social media feeds have more inclusive content and less content that feeds your dysphoria. This can also help affirm and validate your experience.
• Finding supportive places: Many communities have LGBTQIA+-friendly spaces, such as libraries, bookstores, coffee shops, bars, etc. these can be great places to meet accepting individuals and those with similar experiences to you.
• Being gender-affirming: Gender affirmation starts with you; consider dressing in a way that makes you feel euphoric, even if it’s just at home or when you’re by yourself. You can also read affirming books, talk to supportive loved ones, find other ways to feel accepted that suit you, and explore what feels good or congruent to your gender experience.

Though being out and proud helps many people feel more euphoric in their gender experience, you don’t have to be out all the time if you aren’t ready. The best way to support yourself as you experience gender dysphoria is to do things that make you comfortable and happy with people around whom you feel safe. If you still struggle to manage your symptoms and the distress of dysphoria is impacting your well-being, reach out to a LGBTQIA+-specialized mental health professional for personalized support.