This diagnosis was formerly known as gender identity disorder. Because this diagnosis was a controversial one, not unlike the controversy that arose in the 1970s regarding the DSM’s inclusion of homosexuality as a diagnosable mental disorder, the criteria and name of gender identity disorder (GID) has been changed in the DSM-5 to gender dysphoria.
In order for someone to be diagnosed with gender dysphoria today, they must exhibit a strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by six (or more) of the following for at least a 6-month duration:
- repeatedly-stated desire to be, or insistence that he or she is, the other sex
- in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
- strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
- a strong rejection of typical toys/games typically played by one’s sex
- intense desire to participate in the stereotypical games and pastimes of the other sex
- strong preference for playmates of the other sex
- a strong dislike of one’s sexual anatomy
- a strong desire for the primary (e.g., penis, vagina) or secondary (e.g., menstruation) sex characteristics of the other gender
In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.
In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
The disturbance is not concurrent with a physical intersex condition.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).