Abstract
Gender dysphoria (GD) refers to the distress resulting from the discrepancy between a person’s gender identity and that person’s assigned gender at birth. The relationship between GD and psychopathology varies depending on the age of onset, and, accordingly, the role of the mental health professional should be considered at different levels: assessment and diagnosis of GD and of co-occurring psychopathologies, addressing to individualized treatment by identifying each person’s specific needs for well-being, and support throughout the gender role change and the whole medical gender-affirming path (puberty blockers, cross-sex hormone therapy, and surgery). The presence of GD within the main classification manuals of mental health disorders is highly controversial. For some, GD should not be diagnosed as a mental illness as the incongruence between gender identity and gender assigned at birth is not pathological in itself. However, some people struggling with their gender identity may need both psychological and medical care due to the distress deriving from GD itself and from social stigma. The present chapter will describe and discuss the main psychiatric aspects related to the care of GD in childhood, adolescence, and adult age in line with international recommendations and guidelines.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). DSM-5. Washington: American Psychiatric Association; 2013.
World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 1992.
Meyer-Bahlburg H. From mental disorder to iatrogenic hypogonadism – dilemmas in conceptualizing gender identity variants as psychiatric conditions. Arch Sex Behav. 2010;39(2):461–76.
Bockting WO. Psychotherapy and the real-life experience. From gender dichotomy to gender diversity. Sexologies. 2008;17(4):211–24.
Bockting WO, Goldberg JM. Guidelines for transgender care. Int J Transgend. 2006;9(3–4):35.
Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;5:943–95.
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfäfflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2011;13:165–232.
Dhejne C, Van Vlerken R, Heylens G, Arcelus J. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. 2016;28(1):44–57.
Mazaheri Meybodi A, Hajebi A, GhanbariJolfaei A. Psychiatric axis I comorbidities among patients with gender Dysphoria. Psychiatry J. 2014;2014:1–5.
Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, Montori VM. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol. 2010;72:214–31.
Bandini E, Fisher AD, Castellini G, Lo Sauro C, Lelli L, Meriggiola MC, Casale H, Benni L, Ferruccio N, Faravelli C. Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness. J Sex Med. 2013;10:1012–23.
Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, Ferruccio N, Meriggiola MC, Manieri C, Gualerzi A, Jannini E, Oppo A, Ricca V, Maggi M, Rellini AH. Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med. 2014;11(3):709–19.
Fisher AD, Ristori J, Bandini E, Giordano S, Mosconi M, Jannini EA, Greggio NA, Godano A, Manieri C, Meriggiola C, Ricca V, Italian GnRH Analogs Study Onig Group, Dèttore D, Maggi M. Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG. J Endocrinol Invest. 2014;37:675–87.
Fisher AD, Ristori J, Castellini G, Sensi C, Cassioli E, Prunas A, Mosconi M, Vitelli R, Dèttore D, Ricca V, Maggi M. Psychological characteristics of Italian gender dysphoric adolescents: a case-control study. J Endocrinol Invest. 2017;40(9):953–65. https://doi.org/10.1007/s40618-017-0647-5.
Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, Fanni E, Amato AM, Bettini E, Mosconi M, Dèttore D, Ricca V, Maggi M. Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-year follow-up data. J Endocrinol Metab. 2016;101(11):4160–9.
Drescher J, Cohen-Kettenis P, Winter S. Minding the body: situating gender identity diagnoses in the ICD-11. Int Rev Psychiatry. 2012;24:568–77.
Ristori J, Steensma T. Gender dysphoria in childhood. Int Rev Psychiatry. 2016;28:13–20.
Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatry. 2011;16(4):499–516.
Steensma TD, McGuire JK, Kreukels BP, Beekman AJ, Cohen-Kettenis PT. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 2013;52:582–90.
Drescher J. Controversies in gender diagnoses. LGBT Health. 2013;1:10–4.
Castellini G. Gender dysphoria. In: Stanghellini G, Aragona M, editors. An experiential approach to psychopathology. Heidelberg: Springer; 2016.
Lippa RA. The relation between childhood gender nonconformity and adult masculinity–femininity and anxiety in heterosexual and homosexual men and women. Sex Roles. 2008;59(9/10):684–93.
Rottnek M. Sissies & tomboys: gender nonconformity & homosexual childhood. New York: New York University Press; 1999.
Korte A, Goecker D, Krude H, Lehmkuhl U, Grüters-Kieslich A, Beier KM. Gender identity disorders in childhood and adolescence. Dtsch Ärtzenbl. 2008;105(48):834–41.
à Campo J, Nijman H, Merckelbach H, Evers C. Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists. Am J Psychiatr. 2003;160:1332–6.
Fairnburn CG. Cognitive behavioral therapy and eating disorders. New York: Guilford; 2008.
Senol T, Cana AP, Alaattin D. Prolonged anorexia nervosa associated with female –to-male gender dysphoria: a case report. Eat Behav. 2015;18:54–6.
Zucker KJ. Associated psychopathology in children and adolescents with gender identity disorder. In: Meyer-Bahlburg HFL, editor (Chair). From mental disorder to iatrogenic hypogonadism: dilemmas in conceptualizing gender identity disorder (GID) as a psychiatric condition. Symposium presented at the meeting of the American Academy of Child and Adolescent Psychiatry, Chicago; 2008.
Zucker KJ, Bradley SJ, Owen-Anderson A, Kibblewhite SJ, Wood H, Singh D, Choi K. Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. J Sex Marital Ther. 2012;38:151–89.
Zucker KJ, Wood H, VanderLaan DP. Models of psychopathology in children and adolescents with gender dysphoria. In: Kreukels BPC, Steensma TD, de Vries ALC, editors. Gender dysphoria and disorders of sex development, progress in care and knowledge (chapter 9). New York: Springer; 2013.
de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010;40(8):930–6.
VanderLaan DP, Postema L, Wood H, Singh D, Fantus S, Hyun J, Leef J, et al. Do children with gender dysphoria have intense/obsessional interests? J Sex Res. 2014;52:213–9.
Fombonne E. Epidemiology of autistic disorder and other pervasive developmental disorders. J Clin Psychiatry. 2005;66:3–8.
Grossman AH, D’Augelli A. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav. 2007;37(5):527–37.
D’Augelli AD, Grossman AH, Starks MT. Childhood gender, atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. J Interpers Violence. 2006;21:1462–76.
Wallien MSC, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:1307–14.
de Vries A, Cohen-Kettenis PT, Delemarre-Van de Waal H. Clinical management of gender dysphoria in adolescents. Int J Transgenderism. 2006;9:83–94.
Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, Becker J. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res. 2009;47(1):12–23.
Delamarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and pediatric endocrinology aspects. Eur J Endocrinol. 2006;155:131–7.
Spack NP. Management of transgenderism. JAMA. 2013;309(5):478–84.
Auer MK, Hohne N, Bazzara-Castro MA, Pfister H, Fuss J, Stalla GK, Sievers C, Ising M. Psychopathological profiles in transsexuals and the challenge of their special status among the sexes. PLoS One. 2013;8(10):78469.
Lev AI. Transgender emergence. New York: The Haworth Clinical Practice; 2004.
de Vries AL, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex. 2012;59:301–20.
de Vries A, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8(8):2276–83.
Di Ceglie D. Management and therapeutic aims with children and adolescents with gender identity disorders and their families. In: Di Ceglie D, Freedman D, editors. A stranger in my own body: atypical gender identity development and mental health. London: Karnac; 1998. p. 185–97.
Cohen-Kettenis, P. Early interventions with GD adolescents. In: Dettore, D., Ristori, J., Antonelli P. (2015). La Disforia di Genere in Età Evolutiva. Roma: Alpes Italia S.r.l.
Skagerberg E, Parkinson R, Carmichael P. Self-harming thoughts and behaviors in a group of children and adolescents with gender dysphoria. Int J Transgenderism. 2013;14:86–92.
Burgess C. Internal and external stress factors associated with the identity development of transgendered youth. In: Mallon GP, editor. Social services with transgendered youth. Binghamton: Harrington Park; 1999. p. 35–47.
Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health. 2011;81:223–30.
Duncan DT, Hatzenbuehler ML. Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. Am J Public Health. 2014;104(2):272–8.
Hsieh S, Leininger J. Resource list: clinical care programs for gender-nonconforming children and adolescents. Pediatr Ann. 2014;43:238–44.
Khatchadourian K, Amed S, Metzger DL. Clinical management of youth with gender dysphoria in Vancouver. J Pediatr. 2014;164:906–11.
Riittakerttu K, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent in development. Child Adolesc Psychiatry Ment Health. 2015;9:1–9.
Byne W, Bradley SJ, Coleman E, Eyler AE, Green R, Menvielle EJ, Meyer-Bahlburg HFL, Pleak RR, Tompkins DA. Report of the American Psychiatric Association task force on treatment of gender identity disorder. Arch Sex Behav. 2012;41:759–96.
Adelson SL. Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2012;51:957–74.
Hill DB, Menvielle E, Sica KM, Johnson A. An affirmative intervention for families with gender variant children: parental ratings of child mental health and gender. J Sex Marital Ther. 2010;36:6–23.
Steensma TD, Zucker KJ, Kreukels BPC, VanderLaan DP, Wood H, Fuentes A, Cohen-Kettenis PT. Behavioral and emotional problems on the teacher’s report form: a cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm Child Psychol. 2014;42(4):635–47.
Janssen A, Erickson-Schroth L. A new generation of gender: learning patience from our gender nonconforming patients. J Am Acad Child Adolesc Psychiatry. 2013;52(10):995–7.
Saltzburg S, Davis TS. Co-authoring gender queer identities: discursive tellings and re-tellings. J Ethn Cult Divers Soc Work. 2010;19:87–108.
Green R, Fleming D. Transsexual surgery follow-up: status in the 1990s. Annu Rev Sex Res. 1990;1(1):163–74.
Pfafflin F, Junge A. Sex reassignment. Thirty years of international follow-up studies after sex reassignment surgery: a comprehensive review, 1961–1991. Düsseldorf: Symposion; 1998. International journal of transgenderism
Bartolucci C, Gómez-Gil E, Salamero M, Esteva I, Guillamón A, Zubiaurre L, Molero F, Montejo AL. Sexual quality of life in gender-dysphoric adults before genital sex reassignment surgery. J Sex Med. 2015;12:180–8.
Colizzi M, Costa R, Todarello O. Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology. 2014;39:65–73.
Gorin-Lazard A, Baumstarck K, Boyer L, Maquigneau A, Penochet JC, Pringuey D, Albarel F, Morange I, Bonierbale M, Lancon C, Auquier P. Hormonal therapy is associated with better self-esteem, mood, and quality of life in transsexuals. J Nerv Ment Dis. 2013;201:996–1000.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Ristori, J., Fisher, A.D., Castellini, G., Maggi, M. (2018). Psychiatric Aspects of Gender Dysphoria. In: Jannini, E., Siracusano, A. (eds) Sexual Dysfunctions in Mentally Ill Patients. Trends in Andrology and Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-68306-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-68306-5_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-68305-8
Online ISBN: 978-3-319-68306-5
eBook Packages: MedicineMedicine (R0)