Gender dysphoria

Gender identity disorder (GIS) is a psychological or medical diagnosis for people who cannot identify with the sex assigned to them at birth. In Germany and many other countries, a distinction is made in differential diagnosis between transsexuality and gender identity disorder - as a psychiatric diagnosis according to the international classification ICD-10 (F64), which may be based on psychopathological abnormalities and diagnoses of a different nature. In the version ICD-11, which is to be put into force by January 2022 at the latest, the diagnosis changes to "gender deviation": gender incongruence (see below).

As early as 2013, the American Psychiatric Association (APA) replaced the diagnosis of gender identity disorder with gender dysphoria ("gender dysphoria") in its DSM-5 manual. According to the DSM, transgender persons are not considered to be disturbed, nor are non-binary or genderfluid (gender nonconforming) or gay or lesbian persons.

The World Association for Transgender Health (WPATH) already explicitly pointed out in 2010 that a disorder or disease does not describe the person or their identity, but something the person may be struggling with. Accordingly, transsexual, transgender, and gender non-conforming individuals are not considered fundamentally disordered. Rather, it is the suffering from any gender dysphoria that may occur that can be diagnosed and treated.

Since "persistent gender dysphoria in childhood and adolescence is often accompanied by social exclusion and psychiatric comorbidities such as depression as well as self-injurious and suicidal behaviour", Annika Specht and her co-authors state that "adequate care for those affected is extremely important".

Classification

The World Health Organization (WHO) lists the following definitions in the 10th version of its International Statistical Classification of Diseases and Related Health Problems (ICD-10, in effect as of 1994):

• In chapter F64, a distinction is made between "disorders of gender identity in childhood" (F64.2), "transsexualism" (F64.0), "transvestitism with retention of both gender roles" (F64.1) as well as "other" (F64.8) and "unspecified GIS" (F64.9). For childhood GIS, an onset of symptomatology well before puberty is required. The ICD-10 emphatically points out that a mere deviation from cultural gender stereotypes (i.e., mere boyishness in girls or girlishness in boys) is not sufficient for this diagnosis. "Transsexualism" (F64.0) may only be diagnosed in adulthood.
• Transvestitism with retention of both gender roles (F64.1) is to be distinguished from fetishistic transvestitism (F65.1).
• Childhood gender identity disorder (F64.2) should be distinguished from ego-dystonic sexual orientation (F66.1) and sexual maturation crisis (F66.0).

In the 11th version of the ICD, the diagnosis "gender identity disorders" has already been replaced by the technical term "gender incongruence" in 2019; however, ICD-11 will not come into effect until January 1, 2022. Also, the diagnosis is no longer classified as a mental disorder, but as a "condition of sexual health". A distinction is made according to age:

1. HA60: gender incongruence of adolescence or adulthood
2. HA61: gender incongruence of childhood

Criticism of the diagnosis

Some transsexual organisations such as the association Aktion Transsexualität und Menschenrecht criticise the term "gender identity disorder" as unscientific and as an unproven invention of psychoanalysis. Thus, its definition does not take into account the findings of science that neither sex chromosomes nor genitalia of a person can make a clear statement about his or her gender; the concept of a gender identity disorder, however, requires the existence of a "biological sex" from which the psyche of the affected person deviates. Because the gender of a person is much more complex than claimed by psychoanalysis, the view of transsexual persons as people with the desire "to live and be recognized as members of the opposite sex" (ICD-10: F64) does not correspond to reality. Therefore the designation is criticized as well as the evaluation of the gender identity of transsexual people as a psychological disorder. Here some concerned groups see parallels to the pathologization of people with deviant sexual orientation until the beginning of the 1970s as "sexual orientation disorder". In addition, the term gender identity disorder is the main trigger for worldwide transphobia, discrimination and human rights violations, in which many states also participate through corresponding legislation (such as the Federal Republic of Germany with its Transsexual Act introduced in 1980) by adopting unscientific gender stereotypes that are indirectly or directly associated with terms such as gender identity disorder or gender reassignment.

The Yogyakarta Principles are cited, which state, "Contrary to judgments to the contrary, a person's sexual orientation and gender identity are not in and of themselves [...] diseases and therefore should not be treated, cured or suppressed."

The interdisciplinary GIS specialist consultation (adolescent psychiatry, sexual medicine, paediatric endocrinology) established at the Charité since 2007 diagnosed psychopathological abnormalities in all patients (aged five to 17 years; twelve male, nine female) presenting up to mid-2008, which in many cases led to the assignment of a further psychiatric diagnosis. As a rule, clear psychopathological abnormalities were also found in the parents. The background problem or "conversion motive" of the adolescents was predominantly a rejected (ego-dystonic) homosexual orientation. The latter would have been stopped in its development by puberty-blocking measures.