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Gender Dysphoria

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Gender Dysphoria

DJ was recently diagnosed with something the therapist called "gender dysphoria." DJ has very little idea what this means. The therapist talked about how someone like DJ with gender dysphoria typically feels extremely upset inside about the gender they were assigned at birth. They might not feel like they identify with their assigned gender, and this causes pain inside.

Gender dysphoria symptoms

Gender is not the same as sex. Gender usually describes how a person acts and identifies and does not refer to their biological sex. However, the facets of gender masculine or feminine typically apply to the male or female sex. Masculinity is associated with being male and femininity with being female. Problems with gender and sex arise when the two don’t align properly.

Gender dysphoria is a psychological condition defined by the distress produced by a person’s belief that their biological sex does not correspond to their psychological sex (gender identity).

Gender dysphoria was formerly known as gender identity disorder (GID), which was changed after the DSM was updated to be more inclusive in terminology.

Gender Dysphoria Gender Identity Dysphoria StudySmarterGender Dysphoria, Flaticon

Like all disorders, gender dysphoria has specific characteristics by which professionals can tell if a person has it. The symptoms of gender dysphoria are:

  • Strong, negative feelings about one’s birth sex.
  • Feeling that one’s birth sex does not match the gender one identifies with (this is called a gender identity).
  • Desire to have the primary and secondary sex characteristics of the sex you want to identify with (while avoiding or not having the primary and secondary sex characteristics of your birth sex).
  • Symptoms of depression related to their birth sex.

What is the biological explanation for gender dysphoria?

There are biological and psychological explanations for Gender Dysphoria, or Gender Identity Disorder (GID). First, we will look at biological explanations.

Brain structures

Brain gender theory states that differences in brain structures and incompatibility with biological sex cause gender dysphoria. This is usually found in sexually dimorphic brain regions.

Dimorphic brain regions are structures of the brain that serve to identify an individual's birth sex.

Zhou et al. (1995) studied the bed nucleus of the stria terminalis (BSTc), a brain area that plays a role in sexual function. This area is typically 40% larger in males than females. In the post-mortem study, six male-to-female transgender participants were found to have a BSTc size equivalent to typical females. They concluded that this may be due to the interaction between the brain and sex hormones during the developmental period.

Kruizjer et al. (2000) also found similar neurons in the BSTc of male-to-female transsexuals as in females. This finding suggests there is a neurobiological basis for gender identity issues.Hare et al. (2009) examined the genetic components of transsexualism and suggested a particular gene is associated with lower levels of masculinity and the resulting feminisation. They identified an androgen receptor gene (AR) and found that allele repeats of AR were longer in male/female transsexuals than in non-transsexual males.

Gender Dysphoria Males and females have different brain structures StudySmarterMales and females have different brain structures, Flaticon

Genes

Psychological research on atypical gender development has shown genetic factors influence gender dysphoria. Coolidge et al. (2002) examined 157 twin pairs (96 MZ and 61 DZ) for signs of GID using the DSM-4 clinical diagnostic criteria. GID was detected in 2.3% of the pairs, and 62% of these cases were associated with genetic variance GID. This finding suggests a strong genetic component to GID.Heylens et al. (2012) compared 23 MZ and 21 DZ twins in which one of the pairs was diagnosed with GID. They found 39% (9) of the MZ twins had genetic concordance for GID compared to the DZ twins who did not. These data suggest a genetic component to GID.

Concordance in twins indicates the likelihood that twins will develop a particular trait or illness.

People with congenital adrenal hyperplasia (CAH) are more likely to suffer from gender dysphoria. CAH is when someone produces too many male hormones. A mutated gene inherited from the parents has been found to cause the condition. The mutated gene affects an enzyme responsible for 21-hydroxylase. A deficiency in this enzyme is the cause of people with CAH producing too many male hormones.

Girls with CAH may be born with genitals that look similar to those of men. Boys with CAH are likely to reach puberty earlier, and girls may experience the puberty that boys experience. This can lead to gender confusion and the appearance of GID.

Another genetic disorder that may cause the onset of GID is androgen insensitivity syndrome (AIS). This syndrome is inherited from the mother. In AIS, a child is born genetically male (with the X-Y chromosome) but resistant to androgens (male hormones). The individual may have female-like features such as breasts.

Although the person looks like a woman, they still have the genetic makeup of a man. This can lead to confusing feelings about their gender and cause the onset of GID.

What is the social-psychological explanation for gender dysphoria?

Since gender is mainly based on how a person acts and identifies, it is only logical that their social environment influences their gender identity. Psychological components are something we need to consider.

Psychoanalytic theory

One psychological explanation for atypical gender development comes from psychoanalytic theory. Ovesey and Person (1973) argued that extreme separation anxiety in childhood before gender identity is established, causes gender dysphoria. They argued that the child fantasises about symbolically fusing with their mother to alleviate this separation anxiety.

According to their theory, the male child ‘becomes the mother’ and adopts the female gender identity. When interviewed, Stoller (1973) found that men diagnosed with gender dysphoria reported a close mother-son relationship. This likely leads to a stronger female identification and confuses gender identity.

Gender Dysphoria Psychoanalytic theory StudySmarterCloseness to the parent of the same sex may influence gender dysphoria, Yzabelle Bostyn - StudySmarter Originals

Cognitive theory

Dual-path theory another psychological explanation for the atypical development of the sexes comes from the cognitive theory. Liben and Bigler (2002) proposed expanding sex schema theory to emphasise individual differences in gender identity. They suggest gender can take two paths:

  • The ‘normal developmental path’ is when gender develops according to gender schemas and exhibits gender-appropriate’ attitudes and behaviours.
  • The personal path’ describes how a person’s behaviour influences their gender identity rather than society. In this pathway, the person’s behaviour becomes stronger than their gender identity and changes their gender schema.
A boy may grow up wearing dresses and believe that boys and girls can do so. Therefore, his schemas are not sex-typed.

Although the theory uses the terminology ‘normal’, we recognise this term can be considered offensive. By ‘normal’ the theory refers to what is most common.

Gender Dysphoria Dual Pathway Theory StudySmarterCloseness to the parent of the same sex influences GID, Yzabelle Bostyn - StudySmarter Originals

How can we evaluate gender dysphoria explanations?

Considering that explanations revolve around the results of studies, it is important to understand what the results mean and to evaluate their reliability and validity.

The biological explanation for gender dysphoria

Evaluating the biological explanation of gender dysphoria:

  • Conflicting evidence for the BSTc Hulshoff Pol et al. (2006) found that transgender hormone therapy affects the magnitude of the BSTc, although the BSTc should be fully formed by age five. Therefore, the observed differences in the BSTc in patients with gender dysphoria may be a consequence rather than a cause of gender dysphoria.
  • This approach considers only the nature aspect of the ‘nature versus nurture’ debate. It, therefore, ignores the role of the environment. This explanation can be regarded as reductionist.

When an approach is reductionist, it tends to oversimplify complex processes by ignoring factors contributing to behaviour.

The social-psychological explanation for gender dysphoria

Evaluation of the social-psychological explanations of gender dysphoria:

  • Androcentric research Ovesey and Person’s explanation of gender dysphoria only considers male transgender individuals. The research does not consider females, so the theory does not provide a complete explanation of gender dysphoria.

  • Psychoanalytic explanations are difficult to measure and test scientifically because they state gender dysphoria occurs unconsciously.

  • Descriptive versus explanatory Liben and Bigler’s cognitive theory of gender dysphoria is descriptive. The theory describes what causes gender dysphoria. However, it does not explain the underlying processes that cause the development of gender dysphoria.

What gender dysphoria treatments are available?

The most common treatments for people with gender dysphoria are therapy and hormone therapy. Because gender dysphoria can also occur in children, gender reassignment is usually done later. This is the typical medical standard when gender behaviours or feelings change with age.

Gender non-conforming behaviour is when an individual’s behaviour or ascribed gender role does not conform to societal masculine or feminine gender norms.

Hormone replacement therapy

Hormone replacement therapy can impact a person’s physical appearance and physiological processes.

For example, people with high testosterone levels may have increased hair growth.

There are two common types of hormone replacement therapy:

  1. Puberty blockers

  2. Cross-sex hormones

One gender dysphoria symptom is negative feelings toward one’s biological sex. People with gender dysphoria usually try to avoid experiences with their biological sex. Therefore, hormone replacement therapy may be a treatment option for them. It is used to prevent the individual from reaching puberty. They are typically used as a treatment for young adolescents.

Hormone therapy essentially involves increasing the hormone levels of the gender with which the affected person identifies. Testosterone is the hormone associated with the male gender.

Hormones associated with females are estrogen and progesterone.

Therapy

Therapy is the most common treatment used for patients with gender dysphoria. Therapy can serve to:

  • Uncover the causes of gender dysphoria (psychotherapy).

  • Learn how to cope with gender dysphoria (cognitive behavioural therapy).

  • Understand how others can help and understand gender dysphoria (couples or family therapy).


Gender Dysphoria - Key takeaways

  • Gender dysphoria is a psychological condition categorised based on distress caused by the feeling that one’s birth sex does not match one’s gender identity.
  • People with congenital adrenal hyperplasia (CAH) or androgen insensitivity syndrome (AIS) are more likely to suffer from gender dysphoria.
  • The psychoanalytic theory explains gender dysphoria in males by absent fathers and proximity to the mother.
  • The cognitive theory explains gender dysphoria through the dual-pathway theory.
  • Common treatments for helping people with gender dysphoria include hormone replacement therapy and some form of therapy.

Frequently Asked Questions about Gender Dysphoria

The onset of gender dysphoria can happen at any age. But, it usually starts at a young age. 

Gender dysphoria is diagnosed by a trained clinical psychologist. Gender dysphoria is diagnosed after the clinician establishes that the symptoms match a sufficient amount of the DSM-5 criteria.

Gender dysphoria was formerly known as gender identity disorder (GID), which was changed after the DSM was updated to be more inclusive in terminology.

The symptoms of gender dysphoria are: 

  • Strong, negative feelings about one’s birth sex.  
  • Feeling that one’s birth sex does not match the gender one identifies with (this is called a gender identity).
  • Desire to have the primary and secondary sex characteristics of the sex you want to identify with (while avoiding or not having the primary and secondary sex characteristics of your birth sex). 
  • Depression.

Gender dysphoria is a psychological condition defined by the distress produced by a person’s belief that their biological sex does not correspond to their psychological sex (gender identity).

Final Gender Dysphoria Quiz

Question

What is the definition of gender dysphoria?

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Answer

Gender dysphoria is a psychological condition categorised based on the distress caused by the feeling that one’s birth sex does not match one’s gender identity.

Show question

Question

What was gender dysphoria previously known as?

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Answer

Gender Identity Disorder (GID).

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Question

Which brain region did Zhou et al. (1995) identify as sexually dimorphic? 

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Answer

Nucleus accumbens.

Show question

Question

How does the brain sex theory explain gender dysmorphia?

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Answer

Brain sex theory suggests brain structures differences and incompatibility with biological sex cause gender dysphoria.

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Question

What concordance rate did Heylens et al. (2012) find between MZ twins with gender dysmorphia?

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Answer

37%.

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Question

Which criteria did Coolidge et al. (2002) use in their procedure? 

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Answer

DSM-4.

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Question

Is the following statement true or false: ‘Stoller (1973) found that gender dysmorphia was a cause of close mother-son relations’.

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Answer

True.

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Question

Which of the following best describes the psychoanalytic explanation for gender dysmorphia?

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Answer

Anxiety.

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Question

Which of the following is the definition of the ‘normal developmental path’?

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Answer

The ‘normal developmental path’ is when gender develops according to gender schemas and exhibits ‘gender-appropriate’ attitudes and behaviours.

Show question

Question

Which of the following is the definition of the ‘personal path’?

Show answer

Answer

The ‘personal path’ describes how a person’s gender develops according to gender schemas, following ‘gender-appropriate’ attitudes and behaviour.

Show question

Question

Does Hulshoff Pol et al. (2006) support the notion that the BSTc is involved in gender dysphoria? 

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Answer

Yes.

Show question

Question

What is a limitation of the biological explanation for gender dysphoria? 

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Answer

This approach only considers the nature aspect of the nature versus nurture debate. Therefore, it ignores the role of the environment and therefore, this explanation can be considered reductionist. 

Show question

Question

What is a limitation of the psychoanalytic explanation for gender dysphoria? 

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Answer

Psychoanalytic explanations are difficult to measure and test scientifically because they state gender dysphoria occurs unconsciously.

Show question

Question

What does it mean when an approach is considered reductionist?

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Answer

When an approach is reductionist, it tends to over-simplify complex processes by ignoring factors contributing to behaviour. 

Show question

Question

What are the common treatment options available for people diagnosed with gender dysphoria?

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Answer

Treatment options for gender dysphoria are:

  • Hormone replacement therapy.
  • Therapy.

Show question

Question

What does CAH stand for?

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Answer

CAH stands for congenital adrenal hyperplasia.

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Question

Who do children inherit AIS from? 

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Answer

Mother.

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Question

How can AIS lead to the onset of GID?

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Answer

People with AIS may look female but have the genetic make-up of a man, which can lead to confusing feelings regarding their gender and cause the onset of GID. 

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