Gender dysphoria in children DSM 5
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1):
1. 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 assigned gender).
2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of
rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.
B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.
Gender dysphoria in adolescents and adults
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following.
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
2. 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 (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender
different from one’s assigned gender).
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
Prevalence
- For natal adult males, prevalence ranges from 0.005% to 0.014%.
- For natal females, prevalence ranges from 0.002% to 0.003%.
- In children, sex ratios of natal boys to girls range from 2:1 to 4.5:1.
- In adolescents, the sex ratio is close to parity.
- In adults, the sex ratio favors natal males, with ratios ranging from 1:1 to 6.1:1.
- In two countries, the sex ratio appears to favor natal females (Japan 2.2:1; Poland 3.4:1).
Anatomic dysphoria
the desire to have a sexual anatomy corresponding to the experienced gender.
Natal males trajectories of development GD
- early onset: starts in childhood
- late onset: around puberty or later in life; Engaging in transvestic behaviour with sexual excitement, may be more ambivalent and less satisfied after surgery
Natal females trajectories of development GD
- Most common course is early-onset
- With early-onset: almost always gynephilic
- Parents of late-onset females also report surprise, as no signs were evident during childhood
- With late-onset: usually androphilic and after gender transition self-identify as gay men
- With late-onset: no co-occurring transvestic behavior with sexual excitement
Androphilic
natal man attracted to men
Gynephilic
natal woman attracted to woman
Temperamental risk factors
- Atypical gender behavior develops in early preschool age (among individuals with early-onset gender dysphoria).
- It’s possible that a high degree of atypicality makes the development of gender dysphoria and its persistence more likely.
Environmental risk factors
- Males with gender dysphoria (without a disorder of sex development) more commonly have older brothers than do males without the condition.
- Additional predisposing factors (especially in late-onset) include habitual fetishistic transvestism developing into autogynephilia (i.e., sexual arousal associated with the thought or image of oneself as a woman) and other forms of more general social, psychological, or developmental problems).
Physiological factors
• For individuals with GD without a disorder of sex development, some genetic contribution is suggested by evidence for (weak) familiarity of transsexualism among nontwin siblings, increased concordance for transsexualism in monozygotic compared with dizygotic same-sex twins, and some degree of heritability of GD.
Transvestic disorder
heterosexual (or bisexual) adolescents and adult males (rarely in females) for whom cross-dressing behavior generates sexual excitement and causes distress and/or impairment without drawing their primary gender into question.
Body dysmorphic disorder
focus on the alteration or removal of a specific body part because it’s perceived as abnormally formed, not because it represents a repudiated assigned gender.
Body integrity identity disorder
wish to have a healthy limb amputated because they desire to live as an amputee or a
disabled person.
Diagnosis with children with GD dutch approach
Several sessions spread out over a longer period of time allotted to prepubertal children below age 12 for diagnosis.
- -> parents are included, parental counselling
- -> there is no physical interventions before puberty
adolescents diagnosis dutch approach
A diagnostic trajectory is initiated that is spread out over a longer period of time.
- Intake session with adolescent and parents
- Individual talks with parents and youths
- Psychodiagnostic assessment
- -> puberty suppression sometimes
- -> real-life experience stage
Puberty suppression
completely reversible
Cross sex hormones
- partially irreversible intervention
- +16
Gender reassignment surgeries
- completely irreversible interventions
- +18
Mental health among GD
- transwomen are more likely to suffer from psychiatric disorders
extreme male brain theory
women have a stronger drive to empathize whereas men have a stronger drive to systemize.
