DSM5 Presentation on Gender Dysphoria - Ridghaus

Ridghaus Coun 565 - DSM Presentation:Gender Dysphoria

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Understanding the details and limitations of the DSM + some tips for folx wanting to know more and for counselors

SUMMARY

In our field the DSM dictates elements of treatment for clients through insurance. Looking specifically at the DSM criteria for Gender Dysphoria in adults while acknowledging additional diagnoses for developmental stages of adolescent and youth.

DSM 5-TR: Gender Dysphoria - F64.0

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 . . .B.The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Two of the following . . . Six different categories/manifestatios exist for evaluation.

Two of these Six

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. 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).

Leibowitz, S., & de Vries, A. L. C. (2016). Gender dysphoria in adolescence. International Review of Psychiatry, 28(1), 21–35. https://doi.org/10.3109/09540261.2015.1124844

Youth, Adolescents, Adults

Some studies contain persons experiencing clinically diagnosable gender dysphoria as early as 10-13 years old.However, I focus on adults to avoid some of the issues regarding parental/guardian permission.

Crocq, M.-A. (2021). How gender dysphoria and incongruence became medical diagnoses - a historical review. Dialogues in Clinical Neuroscience, 23(1), 44–51. https://doi.org/10.1080/19585969.2022.2042166

History of Pathology

One article around the medical and mental diagnoses of gender dysphoria (was other pathologies)

Greco-Roman

Caenis/Caeneus was granted the ability to become a man after an assault

Krafft-Ebing

Theory of degeneracy from effeminacy to transmutatio sexus influencing pathology

ICD-11

Not all who experience incongruence desire reassignment

Arraiza Zabalegui, M. (2024). After the trans brain: a critique of the neurobiological accounts of embodied trans identities. History and Philosophy of the Life Sciences, 46(1). https://doi.org/10.1007/s40656-023-00602-6

History of Pathology 2

Three efforts to explain the neuro/biological a/etiology all fall short in creating the depathologization desired

Neurobiological

Intrauterine differentiation takes place later than genital sex differentiation resulting in dysphoria.

ND Cortical

Thinning of cortical region may contribute to developing gender incongruence - but underlying this theory is the impact of world influences on body and brain

HSRTBP

Hypothesis of Self-Referential Thinking and Body Perception - least pathologizing but the pendulum swings wide from historical roots

American Psychiatric Association. (2022). Gender Dysphoria. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x14_Gender_Dysophoria

Diagnoses

Gender Dysphoria in Children/Youth is coded as F64.2 and has differering requirements The primary is that 6 of 8 criterion must be identified. GD articulates co-morbidity with anxiety and I wondered, but could not find, if that anxiety came from increasing tension in not being diagnosed (or understood) for a period of time.

Top line is 3%. Self-identifying GD 0.5-0.6%, Experiencing GD 0.6-1.1%, feeling that one is a different gender 2.1-2.6%, and wanting to undergo medical treatment 0.2-0.6%

DSM - Prevalence

In the general US population, the bars represent the percentage of folx in the DSM statistics

World Professional Association for Transgender health (WPATH)

Standards of Care v. 8

Recommended for anyone working with trans folx

Treatment

With the comorbidity of anxiety appearing at significant frequency, some talk therapy and perhaps inneractive therapies like IFS can give clients some clarity about the path forward. They may want hormone treatment, they may want surgery, they may want neither.

Ashley, F. (2021). The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health. Perspectives on Psychological Science, 16(6), 1159–1164. https://doi.org/10.1177/1745691619872987

Treatment:Youth

Unique challenges with youth:1. May not have capacity for Informed Consent 2. Urgency of pre-pubertal treatment 3. Hormones or surgery may result in lifetime sterility

Clayton, A. (2023). Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice. Archives of Sexual Behavior, 52(2), 483–494. https://doi.org/10.1007/s10508-022-02472-8

Jelsma, T. (2022). An Attempt to Understand the Biology of Gender and Gender Dysphoria: A Christian Approach. Perspectives on Science and Christian Faith, 74(3), 130–148. https://doi.org/10.56315/PSCF9-22Jelsma

TherapistsTips

Therapists holding Christian faith may recognize the division various churches hold regarding Gender Dysphoria and trans folx. Tony Jelsma articulates a position consistent with WPATH, ACA Ethics, and religious faith called: the Diversity Approach.

American Psychiatric Association. (2022). Gender Dysphoria. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x14_Gender_Dysophoria

TherapistsTips 2

Social and Environmental considerations aren't exclusively controlling. Even in cultures recognizing diversity of gender, GD/I still shows up.

Bonhomme, L. S. (2019). Gender dysphoria and the mirror: A mediator between the first person and third person perspective. Counselling Psychology Review, 34(1), 51–59. https://doi.org/10.53841/bpscpr.2019.34.1.51

TherapistsTips 3

Laura Bonhomme recommends utilizing acclimating clients to various layers of gender - internal senses, body image, and socialization to give greater clarity into their identities.

Neri, J., Faccio, E., Iudici, A., & Galupo, M. P. (2020). Trans People’s Attitudes and Beliefs Regarding the Diagnosis of “Gender Dysphoria”: Research in the Italian Context. Psychology of Sexual Orientation and Gender Diversity, 7(3), 316–328. https://doi.org/10.1037/sgd0000425Schulz, S. L. (2018). The Informed Consent Model of Transgender Care: An Alternative to the Diagnosis of Gender Dysphoria. The Journal of Humanistic Psychology, 58(1), 72–92. https://doi.org/10.1177/0022167817745217

TherapistsTips 4

Transgender folx sometimes want to have biological children (Neri).& Schulz offers an entire consent model centered in depathologizing the diagnosis with humanistic psychology

If you're not interested in developing affirming practices for folx experiencing Gender Dysphoria - go find a hobby and leave them alone.

- Me

References

Arraiza Zabalegui, M. (2024). After the trans brain: a critique of the neurobiological accounts of embodied trans identities. History and Philosophy of the Life Sciences, 46(1). https://doi.org/10.1007/s40656-023-00602-6 American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787 American Psychiatric Association. (2022). Gender Dysphoria. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x14_Gender_Dysophoria Ashley, F. (2021). The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health. Perspectives on Psychological Science, 16(6), 1159–1164. https://doi.org/10.1177/1745691619872987

Bonhomme, L. S. (2019). Gender dysphoria and the mirror: A mediator between the first person and third person perspective. Counselling Psychology Review, 34(1), 51–59. https://doi.org/10.53841/bpscpr.2019.34.1.51Clayton, A. (2023). Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice. Archives of Sexual Behavior, 52(2), 483–494. https://doi.org/10.1007/s10508-022-02472-8

References (cont.)

Crocq, M.-A. (2021). How gender dysphoria and incongruence became medical diagnoses - a historical review. Dialogues in Clinical Neuroscience, 23(1), 44–51. https://doi.org/10.1080/19585969.2022.2042166 Jelsma, T. (2022). An Attempt to Understand the Biology of Gender and Gender Dysphoria: A Christian Approach. Perspectives on Science and Christian Faith, 74(3), 130–148. https://doi.org/10.56315/PSCF9-22Jelsma Leibowitz, S., & de Vries, A. L. C. (2016). Gender dysphoria in adolescence. International Review of Psychiatry, 28(1), 21–35. https://doi.org/10.3109/09540261.2015.1124844 Neri, J., Faccio, E., Iudici, A., & Galupo, M. P. (2020). Trans People’s Attitudes and Beliefs Regarding the Diagnosis of “Gender Dysphoria”: Research in the Italian Context. Psychology of Sexual Orientation and Gender Diversity, 7(3), 316–328. https://doi.org/10.1037/sgd0000425

Schulz, S. L. (2018). The Informed Consent Model of Transgender Care: An Alternative to the Diagnosis of Gender Dysphoria. The Journal of Humanistic Psychology, 58(1), 72–92. https://doi.org/10.1177/0022167817745217