Caitlyn Jenner’s transition is, what we would call in this day and age, “trending” in social media. But the transgender struggle has existed long before the times when it would have graced the cover of Vanity Fair. Many transgender trailblazers have come before Caitlyn: World War II era Army draftee Christine Jorgensen, former professional tennis player Renée Richards, LGBT advocate Chaz Bono, Hollywood actress Laverne Cox. We live indeed in a different world. A world more accepting about diversity, yet with deeply engrained prejudices. Let us not forget Brandon Teena.
But, What is Gender Dysphoria?
Dysphoria, from the Greek “difficult to bear,” is a sense of discomfort or distress. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5):
“Gender Dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.”1
In other words, people with gender dysphoria are not happy with the sex they were born, identify themselves as members of the other sex, and have significant distress because their sexual characteristics are in conflict with how they view, think, and feel about themselves and their gender.
Previous versions of the DSM used the terminology Gender Identity Disorder, which was included in the “Sexual and Gender Identity Disorders” chapter together with sexual dysfunctions and paraphilias. But gender identity disorder is neither a sexual dysfunction nor a paraphilia. Furthermore, DSM-5 recognizes that gender identity is not the clinical problem and shifts the focus of clinical attention to the distress experienced by the individual. The problem is not the identity but rather the mental anguish that the individual may face when dealing with the thoughts and feelings about their gender.
Not that sexuality and gender identity are this simplistic, but let us think of sex as the anatomical characteristics we have from birth (generally speaking, vagina vs. penis, XX vs. XY chromosomes), sexual orientation as the person to whom we are sexually attracted, and gender as our internal sense of self (as male, female, neither, or both).
Gender dysphoria may begin in childhood but may also be seen later in life. It is more commonly seen in men than women, although these statistics are greatly contested. The level of distress caused by gender dysphoria places the individual at higher risk for behavioral problems, substance use, depression, anxiety, and suicide.
Gender reassignment surgery may not necessarily be the personal goal for all individuals with gender dysphoria. Regardless of the decision, it is important to seek help from an experienced mental health professional in order to deal with the distress caused by the gender incongruence, to treat any resulting or co-occurring mental health problems, and to assist the individual in the transition. While family and peer support is essential, family members may also need psychological assistance to deal with their feelings and the perceived loss of their transgender family member.
Caitlyn is not the first and certainly not the last transgender individual. While her life in the public eye will hopefully bring more attention to this important issue, we need to be mindful of the double-edge sword that comes with her fame. Living under the social microscope, with its heightened level of scrutiny, and in our ever-connected world where comments are unfiltered and, at times, intolerant and insensitive, may not only be damaging to Caitlyn’s journey but may actually hurt the transgender cause.
We have come a long way as a society and it is amazing that we are having this conversation. We must continue to educate ourselves because knowledge is not only power but it also fosters awareness, tolerance, acceptance, and respect.
Remember…
Be Smart. Be Safe. Be Healthy. Be Strong.
Until next time!
Dr. Felix