Is transgenderism a mental disorder? Is gender dysphoria a mental disorder?

[aronarchy]

Useful prerequisite: Defining divergence, disorder, and disability
 
https://www.apa.org/topics/lgbtq/transgender

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder.

https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

The term “transgender” refers to a person whose sex assigned at birth (i.e. the sex assigned by a physician at birth, usually based on external genitalia) does not match their gender identity (i.e., one’s psychological sense of their gender). Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. Though gender dysphoria often begins in childhood, some people may not experience it until after puberty or much later.

Gender dysphoria: A concept designated in the DSM-5 as clinically significant distress or impairment related to a strong desire to be of another gender, which may include desire to change primary and/or secondary sex characteristics. Not all transgender or gender diverse people experience dysphoria.

The DSM-V criteria for gender dysphoria:

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.

 

“Gender” is a rather vague concept; gender stereotypes, norms, and expected roles =/= gender identity. While someone may find that for themself, a certain characteristic (such as preferred/required pronouns) correlates with their gender identity, someone else with the same pronouns might interpret their own correlation differently and have a different gender identity. In response to a Tumblr transmed arguing “if pronouns =/= gender then transphobes would think it’s okay to misgender people” a while ago, I said:

If someone feels their gender is directly correlated to their choice of pronouns, and state that, then intentionally using the wrong pronouns for them is misgendering. If someone feels their gender is unconnected to the pronouns they choose to use, it’s still incredibly rude to purposefully use the wrong pronouns (though it might also be useful to come up with a different name for that instead of “misgendering”).

Likewise, having hobbies generally associated with maleness might to someone be a part of or related to their identity as male, while to someone else might be unrelated to their gender entirely, or be related to her being a girl. Many trans people feel wanting to have genitals generally associated with the other binary gender is related to their gender identity, while some don’t.

(Personally, I currently waver between “my stereotypically gender-neutral or androgynous traits correlate to me being agender” and “none of my other traits apart from my gender identity itself are related, it’s all entirely just a coincidence.”)

Lecter​ told me this in DMs a while ago, and it got me thinking:

I don’t think I want to call my gender dysphoria a disorder. I have a body that’s wrong, not a mind. My gender dysphoria is a reasonable and expected response to living in a body with female sex characteristics. Typically, we say words like disorder/disease/illness for things that could be somehow alleviated on their own to better someone’s life. I can call my OCD or ASPD disorders, because I need coping mechanisms and life strategies for them, and it’s them I target with this treatment. While in case of gender dysphoria, I do not want to treat gender dysphoria. I want to treat my physical body. Gender dysphoria getting easier is a side effect. I’m thinking, all my kinds of dysphoria are actually one, whole dysphoria that is caused by the same issue. The issue being that I'm physically not a tall blond 38 yo cis man. If I focus on the gender component, it’s gender dysphoria. But it’s not separate from everything else I feel about it. I have a mental image of myself, and I see my physical body, and I suffer from the mismatch. If I lived in a sci fi story, was a tall blond cis man, and got my brain and my consciousness put into a body of a short young woman, would the viewers call my distress about it disordered?

There are different facets to gender dysphoria: dysphoria over not being perceived as the correct gender; dysphoria over not being able to make certain changes which would feel gender-affirming; dysphoria over not having a body which you associate with your correct gender. But what if the body dysphoria you felt was unrelated to your gender?

For example, cis people who experience dysphoria about their physical sex characteristics, unrelated to gender identity, would still fall under “sex dysphoria,” and general body dysphoria. Discussions about other forms of dysphoria (i.e. species dysphoria, age dysphoria) have already begun to occur in other communities.

Is gender dysphoria a disorder in and of itself? Or does its caused distress only arise because dysphoric trans people are treated poorly by society, i.e. coercively assigned the wrong gender as birth, assumed to be and treated as the wrong gender, constantly misgendered and deadnamed, and ridiculed and denied autonomy when trying gender-affirming alterations like wearing different clothes, getting a haircut, or having surgery? Would it be “gender dysphoric disorder” if a cis woman was similarly distressed at being constantly mistaken as a man, referred to by he/him pronouns, etc.?

What if she was given hormones or surgery for some reason, and felt severely distressed by the mismatch between the body she had and the body she felt she should have? Would the dysphoria she experiences be a “mental disorder"? In fact, this is a common transmedicalist argument: that nondysphorics who transition will somehow start experiencing a sort of “reverse dysphoria” afterward. It’s based on a very un-nuanced understanding of how dysphoria actually works, assuming for some reason that everyone has only a single “ideal/correct body” they would feel nondysphoric about, and that every other body would automatically cause them severe dysphoria. When in reality, there is usually a wide range of different physical features we would be severely dysphoric over, moderately dysphoric over, somewhat uncomfortable with, okay with, preferring, euphoric over, etc. on a scale.

“Disorder” generally implies optimal improvement comes from reverting to the individual’s state before they were disordered, but dysphoric trans people do not need to become cis in order to no longer suffer from dysphoria; the goal is transition, not conversion therapy. Dysphoria only remains a problem if there is absolutely no body (or lack thereof) which the individual would be non-distressed at having (unlikely), if the required body modifications are currently technologically impossible (then the solution is developing better technology), or if the individual cannot access the modifications (in which case we work on overthrowing the system).