In a recent interview with Oprah Winfrey, Elliot Page opened up about his experiences suffering with a condition called gender dysphoria. He explained how he’d suffer severe panic attacks at premieres and parties because he felt like the world wasn’t seeing him as who he was – a man. He was wearing dresses and heels to events around the world because that’s what people expected of him, but they didn’t represent his gender identity.Similar distress was expressed by Caitlyn Jenner who, before her transition, felt discomfort at the fact that the world perceived her as a man.
But what is gender dysphoria, and how can we identify it, and help those experiencing it?
What is gender dysphoria?
According to the American Psychiatric Association, gender dysphoria presents as “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity”. It occurs in transgender people as early as childhood, but often does not begin until much, much later, when those suffering from it have already been suffering from being misgendered for decades.
The DSM-5 defines gender dysphoria in adults as a marked incongruence between one’s experienced/expressed gender and their assigned gender, generally diagnosed when at least two of the following continue for longer than 6 months:
- 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)
- 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 (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
- A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
- 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)
Though the criteria for diagnosing adults and children vary slightly, in order to meet criteria for the diagnosis, the conditions in both cases must also be associated with distress or impairment in social, occupational, or other important areas.
Korin Miller, writing for Women’s Health, points out one very important issue with the DSM-5’s criteria for diagnosing gender dysmorphia: “Essentially, it’s not enough for someone to feel that they’re being viewed as the wrong gender—they have to be distressed by it”.
Gender dysmorphia can start at any time, although it’s often triggered with the changes that occur around puberty. It also doesn’t necessarily remain constant. It’s a complicated issue and the feelings and anxiety that surround it can fluctuate throughout the course of one’s life. If one is able to express themselves as the gender they identify as, they may suffer less of the effects of it. Others, as in the case of Elliot Page, may feel constant distress about being forced to dress and behave as a gender they don’t identify with.
Other signs of gender dysmorphia
It’s not hard to see why people suffering from gender dysmorphia – particularly for prolonged amounts of time – may also experience a number of other mental health struggles. It’s frequently linked to anxiety, depression, self-harm, social isolation and, in extreme cases, suicide attempts.
They’re likely to have trouble at school if they’re younger, and of course, being unable to present yourself as the person you really are can make social situations challenging. According to Psychology Today, “due to feelings of distress and stigma, many individuals with gender dysphoria become socially isolated—whether by choice or through ostracism—which can contribute to low self-esteem and may lead to school aversion or even dropping out”.
Support, therefore, is crucial. According to Miller, “lack of support from family and society is one of the strongest predictors of transgender people facing mental health issues”.
What can be done?
Helping someone get through gender dysmorphia can involve a number of steps and treatment options. Creating a space in which those struggling with the condition can be open about who they really are is crucial. This can include the exploration of their feelings and experiences with their gender identity, with or without the help of a therapist. Switching to using pronouns or names that they better relate to may also provide some relief, writes Miller.
In some cases, people may choose to undergo surgery or hormone treatments in order to being them physically closer to the gender with which they identify. Regardless of how they choose to proceed, an accepting and understanding support system of loved ones will speed up the process. There are a number of communities online and in person in which those who are trying to overcome gender dysmorphia can go to find support from others who have dealt with the same challenges.
In all cases, the best outcomes for those with gender dysphoria are associated with early diagnosis, a supportive and understanding environment, and comprehensive treatment that respects the wishes and desires of the person dealing with the condition.
Even if this is a condition to which you can’t relate, a little bit of empathy goes a long way. In a world in which we’re all striving for greater equality, this too is an arena in which we all need to play our part.