Understanding Gender Dysphoria

A person has gender dysphoria when they experience discomfort caused by a difference between their assigned or recorded gender from birth and the gender with which they identify. For example, if someone identifies as female but was assigned a male gender when they were born, they may experience gender dysphoria.

Gender dysphoria is the mental health diagnosis that is currently given to transgender and gender non-binary individuals who may be seeking gender-affirming care to align their bodies to their gender identities.

Gender dysphoria was previously referred to as gender identity disorder. However, in recent years it has been clearly established that having a gender identity different from the one associated with your assigned sex is not a disorder or problem.

Instead, the problem is experiencing psychological or physical discomfort because your gender identity is not aligned with your recorded sex. (People whose gender identity is aligned with their recorded sex are referred to as cisgender.)

Homosexual couple spending time together and laughing in the city
FatCamera / Getty Images

Diagnoses in Adults and Adolescents

The diagnostic criteria used for identifying gender dysphoria are defined by the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders—the DSM-V. In order for an adolescent or adult to be diagnosed with gender dysphoria, they need to have at least two of the defined symptoms.

Furthermore, the symptoms must last for at least six months, and they must cause significant distress or problems functioning. The symptoms that may be present in adolescents and adults with gender dysphoria include:

  • A marked difference between their experienced or expressed gender identity and the primary or secondary sexual characteristics of their body (feeling that their body doesn't fit)
  • A strong desire to be rid of their primary or secondary sex characteristics
  • A strong desire to have the primary or secondary sex characteristics of the sex that they were not assigned at birth (for instance, someone assigned male wants female sex characteristics)
  • A strong desire to be a different gender
  • A strong desire to be treated as a different gender
  • A strong belief that they have the feelings and reactions that are usually associated with a different gender

There is a growing recognition that gender dysphoria does not only occur across two binary sexes, which are male and female. This is also why there has been a move from terminology such as "cross-sex hormone therapy" to "gender-affirming hormone therapy."

Diagnoses in Children

There are different criteria for gender dysphoria in children than there are in adolescents and adults. First off, they need to have six symptoms associated with significant distress—and as with adults, those symptoms have to last at least six months. Symptoms in children include:

  • A strong desire to be a different gender or believing they are a different gender
  • Strongly preferring to wear clothes associated with a different gender
  • Strongly preferring other gender roles in imaginary play
  • Strongly preferring toys and other activities stereotypically used by a different gender
  • Strongly preferring playmates of a different gender (in general, children prefer same-gender playmates through much of childhood)
  • Strongly rejecting toys and games usually associated with their assigned gender
  • Strongly disliking their sexual anatomy
  • Strongly wanting the physical characteristics that match their gender identity

Children are required to have more symptoms than adults for a gender dysphoria diagnosis because any one or two of these symptoms on their own does not necessarily reflect persistent gender identity concerns. Some children just share more interests with children of the other gender, and some find other-gendered clothes more convenient or comfortable.

Other-gendered behaviors don't necessarily mean a child has a sex-atypical gender identity or gender dysphoria. Gender-atypical behavior is expected as part of normal childhood development.

It is only when these behaviors persist or cause distress that they're likely to be associated with persistent gender dysphoria.

Incidence of Gender Dysphoria

Children generally start developing gendered behaviors sometime between the ages of two and four years old. At this time, children start labeling the gender of others as well as their own. Some children who will later grow up to be transgender start labeling themselves as a gender other than the one associated with their assigned sex as early as this time.

However, this is the exception rather than the rule. Other children may experience gender-atypical behavior but not self-label. Still others may not recognize their gender dysphoria until puberty or even adulthood. It is not uncommon for transgender adolescents and adults to say something like, "I knew something was different, but didn't know what it was until I learned about other people who are transgender."

It is important to note that not all individuals who identify as transgender or gender non-binary experience gender dysphoria.

Gender dysphoria is defined by the discomfort it causes. It is possible to have an atypical gender identity, including having many of the gender dysphoria symptoms, without experiencing significant distress or trouble functioning. This is more likely to occur in a supporting and accepting environment. If such individuals seek out gender-affirming medical or surgical care, they may still be given a diagnosis of gender dysphoria, because the diagnosis is usually required in order to access care.

According to the DSM-5, gender dysphoria is relatively rare. However, there is some evidence that the prevalence is markedly higher than previously reported.

History of the Diagnosis

There are records of individuals with gender identities that do not match their assigned sex across cultures and throughout history. Furthermore, scientists began to experiment with what used to be known as sex-reassignment surgery as early as the 1920s. However, the notion that gender dysphoria could be a diagnosable condition did not arise until much later.

The modern history of the diagnosis of gender dysphoria is a reflection of the modern history of the DSM. The first edition of the DSM was published in 1952. It was intended to help clinicians identify people with the symptoms of the roughly 100 diagnoses included. The second edition, published in 1968, had almost twice the number of diagnoses. That number kept growing with the third edition, published in 1980, and its revision, published in 1997.

The DSM-IV, published in 1995, had about 400 diagnoses. When the DSM-V was published in 2013, it contained more than a hundred additional diagnoses—for a total of more than 500.

It was not until the DSM-III that variations in gender identity and presentation were identified as associated with any type of mental health diagnosis. At that time, two disorders were defined. The first, which described gender dysphoria in adolescents and adults, was called transsexualism. The second, which described the condition in children, was labeled gender identity disorder of childhood. In the DSM-IV, these diagnoses were combined into the category "gender identity disorder," which became what is now known as gender dysphoria.

However, it was not only the names of the condition that would change over time. There were also fundamental differences in how the disorder was understood. That can be seen in the way that gender diagnoses were categorized in the different editions of the DSM.

  • DSM-III: Gender disorders were called "psychosexual disorders"
  • DSM-III-R (revised): This version said that gender disorders were usually first evident in infancy, childhood, or adolescence
  • DSM-IV: Identifies sexual and gender identity disorders
  • DSM-V: Gender dysphoria becomes its own section, separate from sexual dysfunction diagnoses

Initially, a cross-gender identity was seen as indicating that the person was delusional or neurotic. Later, it was seen as a form of deviant sexuality. Understanding the experience of gender dysphoria has continued to evolve over time.

Today, individuals who have a gender identity different from that associated with their assigned sex at birth are considered to represent normal variation. They are only considered to have a mental health condition if their gender identity causes them problems with functioning or distress.

This recognition of gender diversity as normal variation is also reflected in the way that medical providers interact with individuals with gender dysphoria. Doctors, nurses, and other physical health providers use the World Health Organization's International Classification of Diseases (ICD) to diagnose their patients, not the DSM. As of Spring 2018, the ICD-11 contains a new diagnosis.

That diagnosis is gender incongruence, and it has been moved from a mental health diagnosis to one affecting sexual health. This represents an important step forward in destigmatizing gender variance and transgender identities.

It recognizes that when transgender and gender non-binary people seek medical treatment, they're not seeking to treat their gender. They're seeking to address the fact that their bodies do not match who they are inside.

1 Source
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kaltiala-Heino R, Työläjärvi M, Lindberg N. Gender dysphoria in adolescent population: A 5-year replication study. Clinical Child Psychology and Psychiatry. 2019;24(2):379-387. doi:10.1177/1359104519838593

Additional Reading
  • American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Beek TF, Cohen-Kettenis PT, Kreukels BP. Gender incongruence/gender dysphoria and its classification history. Int Rev Psychiatry. 2016;28(1):5-12. doi:10.3109/09540261.2015.1091293

  • Blashfield RK, Keeley JW, Flanagan EH, Miles SR. The cycle of classification: DSM-I through DSM-5. Annu Rev Clin Psychol. 2014;10:25-51. doi:10.1146/annurev-clinpsy-032813-153639

  • Drescher J. Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD. Int Rev Psychiatry. 2015;27(5):386-95. doi:10.3109/09540261.2015.1053847

By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.