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The DSM-5 Diagnostic Criteria for Gender Dysphoria

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Abstract

This chapter provides a summary of the DSM-5 diagnosis of gender dysphoria, including the changes to the criteria and the rationales regarding conceptual shifts. It reviews the substantive changes from the previous diagnosis of gender identity disorder as it was conceptualized and operationalized in DSM-IV.
... Is gender identity "a volitional choice?" This question might sound trivial, but to those who experience gender incongruence (GI) and the ensuring dysphoria, it is of relevance (Zucker 2015;Beek et al. 2016). GI is defined as a marked incongruence between one's experienced gender and one's gender assigned at birth. ...
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Gender incongruence (GI) is characterized by a feeling of estrangement from the own body in the context of self. GI is often described in people who identify as transgender. The underlying mechanisms are unknown. Data from MRI measurements and tests of own body perception triggered us to pose a model that GI in transgender persons (TGI) could be associated with a disconnection within the brain circuits mediating the perception of own body as self. This is a departure from a previous model of sex atypical cerebral dimorphism, introducing a concept that better accords with a core feature of TGI. The present MRI study of 54 hormone naive transmen (TrM), 38 transwomen (TrW), 44 cismen and 41 ciswomen show that cortical gyrification, a metric that reflects early maturation of cerebral cortex, is significantly lower in transgender compared with cisgender participants. This reduction is limited to the occipito-parietal cortex and the sensory motor cortex, regions encoding own body image and body ownership. Moreover, the cortical gyrification correlated inversely with own body-self incongruence in these regions. These novel data suggest that GI in TGI may originate in the neurodevelopment of body image encoding regions. The results add potentially to understanding neurobiological contributors to gender identity.
... Thus, a person realising that most of their preferred activities are male-associated might feel themselves to inhabit a male gender, irrespective of their biological sex. Conversely, another person may have a predominantly male gender expression but feel themselves to be purely female because of their biological sex, so gender identity can be completely different from gender expression (Pullen Sansfaçon et al., 2020;Zucker, 2015). Gender nonconformity in this sense of gender expression differing from gender identity is common, but not universal, in the lesbian and gay community, for example (Mackay, 2019;Rieger et al., 2010). ...
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... The UW definition is however correct in that while intersex and transgender are often conflated, intersex is a unique although rare genetic condition, and unlike transgender (formally known as gender dysphoria) it is not a mental disorder. (Zucker, 2015) White privilege -UW: -Refers to the unquestioned and unearned set of advantages, entitlements, benefits and choices bestowed on people solely because they are white. Generally, white people who experience such privilege do so without being conscious of it." ...
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The most widely used and influential typologies for transsexualism and gender identity disorder (GID) in adolescents and adults employ either sexual orientation or age of onset of GID-related symptoms as bases for categorization. This review compares these two typological approaches, with the goal of determining which one should be employed for the diagnosis of GID in Adolescents or Adults (or its successor diagnosis) in the forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Typologies based on sexual orientation and age of onset of GID-related symptoms are roughly comparable in ease and reliability of subtype assignment. Typologies based on sexual orientation, however, employ subtypes that are less ambiguous and better suited to objective confirmation and that offer more concise, comprehensive clinical description. Typologies based on sexual orientation are also superior in their ability to predict treatment-related outcomes and comorbid psychopathology and to facilitate research. Commonly expressed objections to typologies based on sexual orientation are unpersuasive when examined closely. The DSM should continue to employ subtypes based on sexual orientation for the diagnosis of GID in Adolescents or Adults or its successor diagnosis.