Gender Dysphoria: Agnes B. Padilla MD, DPBP, Fppa

GENDER DYSPHORIA
AGNES B. PADILLA MD, DPBP, FPPA

• DSM IV TR
– GENDER IDENTITY DISORDER
• DSM V
– GENDER DYSPHORIA
REASONS FOR CHANGING
• AVOID STIGMA
the term gender identity disorder has a
stigmatizing effect
dysphoria removes the stigma that the
individual is “disordered”
• ENSURE CLINICAL CARE

GENDER DYSPHORIA
• A condition in which a person feels that there
is a mismatch between their biological sex and
their gender identity
GENDER IDENTITY
• A PSYCHOLOGICAL STATE THAT REFLECT’S THE
PERSON’S SENSE OF BEING MALE OR FEMALE
• DEVELOPS BETWEEN 2 TO 3 YEARS OLD AND

CORRESPONDS TO ONE’S BIOLOGICAL SEX
• DEVELOPS FROM CUES RECEIVED FROM

PARENTS AND THE CULTURE AT LARGE THAT
ARE IN REACTION TO THE INFANT’S GENITALIA
GENDER ROLE
• EXTERNAL BEHAVIORAL PATTERN THAT
REFLECTS A PERSON’S INNER SENSE OF BEING
MALE OR FEMALE
GENDER NONCOMFORMITY IS NOT IN
ITSELF A MENTAL CONDITION
Critical Element In Diagnosis
*
Presence of clinically significant distress
associated with the condition
EPIDEMIOLOGY
• ESTIMATES ARE TAKEN FROM PEOPLE WHO
SEEK SEX REASSIGNMENT SURGERY
• MORE MALE THAN FEMALE WHICH MEANS A
GREATER MALE VULNERABILITY
etiology
• Biologic factors
• Not clear of the role of testosterone
• Gender identity results more from postnatal
life events rather than prenatal hormonal
organization
Psychosocial factors
• Assigned sex- children develop gender identity
according to what sex they were reared
• Interaction between the child’ temperament
and parent’s qualities and attitudes
• Sigmund Freud-result from unresolved conflict
within the oedipal triangle
– Interference with the child’s loving the opposite
sex parent and identifying with the same sex
parent
Maternal factors
• Quality of mother-child relationship in the first
years of life is important
** mothers in this stage facilitate the child’s
awareness of, and pride in, their gender
**children are valued as little boys or girls but

devaluing, hostile mothering can result to
gender problems
Maternal factors
• Separation-individuation problems – leads to
shifts between a desperate infantile closeness
and a hostile devaluing distance
***Children get the message that they will be
valued more if they adopted the gender of the
opposite sex
***Abused or rejected children may act on such
a belief
Maternal factors
• A young boy may react to maternal death,
extended absence or depression by totally
identifying with her– by becoming a mother
and replacing her
Paternal factors
• Also important in early years
• Without a father, mother and son may be
overly close
• For a girl, the father may be the prototype of
future love objects
• For a boy, the father is the model for male
identification
Characteristics of the condition
• Marked difference between the individual’s
expressed/experienced gender and the gender
others would assign him or her
• STRONG AND PERSISTENT CROSS-GENDER
IDENTIFICATION
*Condition must be present for at least 6
months
IN CHILDREN
• The desire to be of the other gender must be
present AND verbalized
In all age groups
• The condition must cause clinically significant
distress or impairment in social, occupational,
or other important areas of functioning
• THE MISMATCH BETWEEN THE ASSIGNED SEX
AND THE GENDER IDENTITY CAN CAUSE
FEELINGS OF DISCOMFORT
– Dysphoria
DSM V
• Adds a post-transition specifier for people
who are living full time as the desired gender
– (with or without legal sanction of the gender
change)
** this ensures treatment access to individuals who
continue to undergo hormonal therapy, related
surgery, or psychotherapy to support their gender
transition
TRANSSEXUAL
• LIVES ACCORDING TO THEIR GENDER IDENTITY
RATHER THAN THEIR BIOLOGIC SEX
• UNDERGO TREATMENT SO THEIR PHYSICAL

APPEARANCE IS MORE CONSISTENT WITH
THEIR GENDER IDENTITY
Behavioral manifestation
• Strong desire to be treated as the other
gender
• To be rid of one’s sex characteristics
• Strong conviction that one has feelings of and

reactions typical of the other gender
EARLY SYMPTOMS
• Children
– may refuse to wear typical boy’s or girl’s wear
– Dislike taking part in typical boy’s or girl’s games
and activities
* in most cases, this behavior is a normal part of
growing up but in cases of gender dysphoria , it
persists into later childhood and through to
adulthood
Symptoms
• IN ADULTS
– They feel trapped inside a body that does not
match their gender identity
– Unhappiness over social expectations that they
have to live according to their anatomical sex
rather than what they feel about themselves
– Causes discomfort and anxiety
– May experience a strong desire to change/get rid
of the physical signs of their biologic sex-
e.g. facial hair or breasts
TREATMENT OPTIONS
• Counseling/psychotherapy
• Cross-sex hormones
• Gender reassignment surgery
• Social and legal transition to the desired
gender

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GENDER DYSPHORIA

AGNES B. PADILLA MD, DPBP, FPPA

• ENSURE CLINICAL CARE

• DEVELOPS BETWEEN 2 TO 3 YEARS OLD AND

• DEVELOPS FROM CUES RECEIVED FROM

**children are valued as little boys or girls but

• UNDERGO TREATMENT SO THEIR PHYSICAL

• To be rid of one’s sex characteristics

• Strong conviction that one has feelings of and

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