In the field of adolescent psychological counseling, I have encountered many children with gender identity issues. Today, I heard that the psychological consulting editor will popularize the existence of this group for everyone and provide them with more understanding and support.
01
What is Gender Dysphoria?
Let us first understand some concepts. Most people’s gender identity is highly consistent with their biological sex, and these people are called “cisgender.”
There are some people whose self-identified gender differs from their biological sex, known as “transgender.” For example, someone assigned male at birth but identifies as female, or vice versa.
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Gender dysphoria, also known as gender incongruence or gender dysphoria, refers to psychological anxiety caused by the inconsistency between a person’s gender identity and their biological sex. They detest their own gender and may strongly desire to be another gender, leading to mental distress and anguish.
This inconsistency can severely impede a person’s development in learning, work, and social aspects, potentially leading to issues such as depression, anxiety, and severe self-harm.
They may feel unsatisfied or even deny their primary and secondary sexual characteristics and develop a strong desire to change their gender identity. They prefer wearing clothes of the opposite sex, imitating the voice, expressions, and postures of the opposite sex, and participating in activities preferred by the opposite sex.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA) in 2013, gender dysphoria (or “gender dysphoria”) was introduced as a new definition to replace gender identity disorder.
The book emphasizes that feeling uncomfortable with one’s biological sex itself is not a disease, and “gender dysphoria” should be used to refer to the anxiety and depressive symptoms related to or caused by this, marking the depathologization of transgender issues. Subsequently, differences in gender identity are no longer classified as normal or abnormal.
Feeling anxious about one’s biological sex does not belong to mental disorders and is not a pathological issue, nor is it related to sexual orientation.
Gender dysphoria primarily causes psychological distress and discomfort, leading to a significant secular pressure to change gender or live in another gender identity.
Among those who do not identify with their assigned gender, 70% experience gender dysphoria. The majority of them have had suicidal thoughts. Statistics show that the suicide rate among transgender individuals is 5 times higher than that of the general population.
Many individuals with gender dysphoria share experiences of self-harm and self-injury. More alarmingly, some even engage in self-mutilation of their genitalia, a highly dangerous behavior occasionally seen in the transgender community.
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02
What does it feel like to experience gender dysphoria?
Let’s take a look at the sharing from netizens:
“Uncomfortable. I feel uncomfortable all over, no energy. I feel like something is restricting me, like a dancer with shackles dancing.”
“Where should I go to the bathroom?… I hope to use the bathroom that corresponds to my gender mentally, but I feel unsafe.”
“Why was I given a boy’s body? I’m clearly a girl! I hate my body, I hate my voice. I was scolded by my dad for wearing a skirt at home. It’s really uncomfortable, I feel like I have depression.”
“I extremely dislike filling out ‘gender’ in some registrations, surveys, etc., because there are only two options, male and female, and I can’t relate to either of them.”
“Feel extremely lonely, difficult to express emotions, cannot trust others. Because people around me always say I’m a girl, I can only keep thoughts like ‘I’m clearly a boy’ to myself, constantly suppressing myself.”
“‘Why are all girls, they can wear the clothes they like, take care of their long hair, while I have to appear here as a boy?’ Ordinary classmates cannot understand us at all, it’s impossible to find someone to confide in, impossible to cry.”
“I am often bullied at school, I want to be a girl, have secretly worn a skirt a few times, put on lipstick, but was ridiculed by classmates as ‘neither male nor female’ ‘abnormal.’ I can only cry secretly, dare not tell my parents, afraid they will scold me.”
The conflicting experiences mentioned above are the daily experiences of individuals with gender dysphoria.
Gender dysphoria mostly begins before puberty clinically, without apparent causes; some individuals with gender dysphoria even start experiencing intense gender dysphoria from their earliest childhood.
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From the perspective of developmental psychology:
– The vast majority of people establish their own and others’ gender by the age of 2.
– By ages 3 to 5, they increasingly understand the differences between males and females.
– By the age of 7, most individuals form a permanent understanding of gender. For example, realizing that even if their mother cuts her hair very short, she remains a female.
– By ages 10-25, the vast majority of people will undergo a change in gender cognition, sometimes even experiencing temporary self-exploration or exploration with others.
For example, boys may consider and even experiment with the possibility of wearing a skirt during this stage, or suddenly develop feelings of love for someone of the same sex.
This stage is actually when children further explore their gender identity, an essential process in figuring out the kind of person they want to be.
Some of these scenarios disappear within two years, but some individuals do achieve new self-understanding after this process.
The vast majority of individuals with gender dysphoria distinctly realize their gender confusion in terms of gender from an early age, but due to the influence of family and societal culture, they often strive to make their behavior conform to the expectations of those around them for boys or girls.
Only 10% of cases of gender dysphoria can be identified before puberty, with the vast majority being diagnosed during puberty due to the prolonged distress experienced in bodily changes, psychological development, and relationships.
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03
How to deal with gender dysphoria?
Treating gender dysphoria patients does not involve forcing them to accept their biological sex but rather reducing the stress and anxiety of individuals with gender dysphoria to improve their quality of life. Currently, there are three progressive treatment methods.
One, Psychotherapy
Some children show signs of gender dysphoria at the age of two, vehemently resisting being dressed in the style of their biological sex by their parents.
For these children, an approach of “watchful waiting” can be adopted, and interventions such as psychotherapy can be used; in most cases, gender dysphoria disappears after adulthood.
Whether it is child patients, adolescents, or adult patients, listening to their grievances and confusion, providing them with a friendly environment, and addressing the negative effects of gender dysphoria and stigmatization on mental health are effective therapeutic methods to alleviate gender dysphoria. As they learn to coexist peacefully with their surroundings, gender dysphoria will gradually diminish.
Two, Hormone Therapy
Hormone therapy can help transgender individuals suppress “unwanted” secondary sexual characteristics and enhance “desired” secondary sexual characteristics.
Three, Gender Reassignment Surgery
Gender reassignment surgery (gender affirming surgery, GAS) is considered one of the methods to alleviate gender dysphoria, and many individuals experience significant relief from gender dysphoria after the surgery.
However, before undergoing surgery, a thorough professional physical and mental assessment must be conducted, and the question of which conditions individuals must meet to undergo gender reassignment surgery is controversial in different cultures.
It is important to note that even surgical treatments have limitations; there are reports indicating that for some individuals, gender dysphoria does not alleviate after surgery, but worsens, and some even regret undergoing this irreversible procedure.
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If you suspect that you have gender dysphoria, it is crucial to seek evaluation from a mental health professional with relevant experience and seek psychological help early.
For many individuals who do not have gender dysphoria, what they can do is to stop stigmatizing individuals with gender dysphoria; every person in the world is different, and perhaps through more education and efforts from more people, the gender dysphoria community will have more understanding and space in daily life.
END
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