Definition

Gender identity disorder, also known as gender dysphoria, refers to a situation where an individual experiences a mismatch between their biological sex and gender identity. For instance, a person who was assigned male gender at birth may identify themselves as a woman, or vice versa. It is not uncommon for individuals with gender dysphoria to feel that they exist somewhere between the traditional male-female binary and identify as non-binary. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes and defines this condition.

The mismatch between societal gender norms and one's gender identity can lead to significant stress, anxiety, and depression.

It is important to understand that gender dysphoria is not the same as sexual orientation. Sexual orientation refers to a person's emotional, romantic, and sexual attraction to a specific gender, such as opposite-sex attraction (heterosexual), attraction to both genders (bisexual), attraction to the same gender (homosexual), or no sexual attraction (asexual).

It is important to remember that gender dysphoria is not a disease. However, it can be associated with mental health disorders, such as anxiety disorders, schizophrenia, depression, eating disorders, and suicide attempts. It is estimated that 7 out of 10 people with gender dysphoria will be diagnosed with a mental health disorder during their lifetime.

If gender dysphoria persists beyond puberty, it is likely to continue into adulthood

Causes

The exact cause of gender dysphoria is still unknown, but it is believed to be the result of a complex biopsychosocial relationship.

Risk factor

Several things that could potentially increase the risk of gender dysphoria in the form of:

• Androgen insensitivity syndrome is caused by congenital adrenal hyperplasia (a derived disease that causes the physical appearance of women to appear more masculine)
• Exposure phthalates in plastic and polychlorinated biphenyls. These two substances are known to interfere with endocrine regulations that determine sex in the fetus before birth
• Disorders in neuroanatomicity. It was found that there was a failure of neuronal development and differentiation (neural cells) related to the hypothalamus
• Genetics/derivatives 

Symptoms

Individuals experiencing gender dysphoria feel persistent discomfort or distress with their assigned gender, typically lasting at least six months.

At a child's age, to meet the criteria for gender dysphoria, a child must have at least six of the following symptoms:

• Insisting on or strongly desiring a gender different from that identified at birth
• Wanting to wear clothing of the gender they express or identify with
• They strongly prefer friends of the gender they self-identify with
• Highly enjoys toys, activities, and games that are usually intended for the opposite gender identified at birth
• Refuse masculine or feminine toys, games, and activities that do not match their self-identified gender
• Dislike of one's genitals at birth
• A solid desire to have sexual characteristics of the opposite sex to match those of their preferred gender, such as breasts or a penis

To diagnose adolescents and adults, they need to have at least two of the following symptoms:

• Feeling certain that their gender identity does not align with their physical body
• Having a strong desire to alter or remove their genitals or other sexual characteristics
• Feeling a strong urge to possess sexual characteristics that are consistent with their gender identity
• Desiring to be recognized and treated as a different gender
• Holding deep-seated beliefs about their true gender identity
• Presenting themselves through clothing and other means in a way consistent with a gender different from the one assigned at birth. 

Diagnosis

The doctor will make a diagnosis of gender dysphoria based on:

• Behavioral health evaluation.

The doctor will assess various factors to confirm whether your sexual identity aligns with the sex assigned to you at birth. This assessment will take into account your personal history, the impact that societal stigma surrounding gender nonconformity has on your mental health, as well as the level of support you receive from your family, friends, or peers.

• Diagnostic and Statistical Manual of Mental Disorders 5 or DSM-5 and PPDGJ 3.

Doctors can make a diagnosis using guidelines from DSM 5 or PPDGJ 3. In Indonesia, a psychiatric diagnosis guide in the form of PPDGJ 3 is also used.

Management

If they don't get proper management, people with gender dysphoria tend to be more at risk of having suicidal ideas and even attempting suicide because of the pressure they feel. After gender reassignment, the risk of suicide in people with gender dysphoria remains, so treatment by professionals is very necessary.

The primary objective of treating gender dysphoria is not to alter an individual's feelings towards their gender. The purpose of treatment is to alleviate the distress and other emotional struggles experienced by individuals with gender dysphoria. Treatment approaches are tailored to the specific needs of each individual, and what works for one person may not necessarily work for another.

Individuals with gender dysphoria can benefit from the help of a psychiatrist or psychologist to receive the most effective treatment. To maintain good mental health, they can also engage in several self-care practices, such as joining a support group, prioritizing their well-being, and practicing mindfulness or prayer to alleviate their emotional distress.

Complications

Gender dysphoria is a condition that can have a significant impact on an individual's life. Those who experience gender dysphoria often feel pressured to conform to the gender they were assigned at birth. Unfortunately, they may also face harassment, discrimination, and insults related to the gender they identify with. As a result, individuals with gender dysphoria may feel uncomfortable attending school or work, leading to dropping out or unemployment.

Individuals with gender dysphoria often face challenges in forming and maintaining relationships. This can lead to various mental health issues such as depression, anxiety, self-harm, eating disorders, and substance abuse. Unfortunately, seeking mental health services can also be difficult for these individuals due to the social stigma surrounding gender dysphoria. They may feel hesitant or embarrassed to seek help, which can further exacerbate their struggles.

Prevention

There is no specific prevention to prevent gender dysphoria. However, prevention can be done by monitoring risk factors such as:

• Avoid exposure to phthalates in plastics and polychlorinated biphenyls. 
• Pregnant women should have regular check-ups with their obstetrician.

When to see a doctor?

It is important to seek medical attention immediately if you experience any of the symptoms mentioned. You may also consider consulting with a psychiatrist or psychologist to determine next steps. Early treatment can significantly enhance your quality of life.