Qu'est-ce que la Dysphorie de genre? (document en anglais)

Gender Dysphoria

1. Describe the disorder

-Include signs and symptoms (clinical manifestations)

Individuals suffering from gender dysphoria are people who strongly and persistently identify with the opposite gender they were born with, often feeling uncomfortable with their own body and assigned or determined sex. Before digging deeper in the subject, three words associated with gender dysphoria terminology must be clarified in order to use the right vocabulary in the appropriate context. Firstly, the term cisgender is used to describe people who, for the most part, identify as the gender they were assigned at birth. Secondly, transgender can be defined as individuals that do not conform to the gender role expectations socially assigned to their sex. It is also used by people who may clearly identify their gender as the opposite of their biological sex (Pinero, 2014). Lastly, transsexual relates to individuals with the biological characteristics of one sex who identify themselves as the opposite gender and have had some type of surgical alteration and/or hormone treatments that changes their body’s appearance in alignment with their identity (Pinero, 2014). Transsexuals can either be female-to-male or male-to-female. Since the term gender dysphoria can seem a bit ambiguous to one’s ear, the emphasis will be put on transgender and transsexual individuals because they are more susceptible of seeking multiple types of treatments in order to significantly improve their quality of life.

Pursuing with the signs and symptoms linked to gender dysphoria, it is important to underline that no physical symptoms are associated with this disorder, only ambiguous psychological ones. As a matter of fact, it is possible that individuals experience a wide variety of feelings and display an assortment of behaviors proper to people living with this condition. All too often, persons with gender dysphoria will start to feel a dichotomy between their biological sex and gender identity early on during their childhood ("Symptoms of gender dysphoria - Health Exchange. 2013"). As a consequence, symptoms tend to vary with age and are frequently affected by the person’s social environment. For example, children may exhibit disgust for their own genitals, express the desire to be the opposite or manifest belief that once they become grown-ups, they will magically transform into the opposite sex. Many times, they are rejected by other children and have to deal with loneliness. On the other hand, adults may start to dress like the opposite gender and express the will to alter their sex. Sadly, they are extremely lonely people and it may happen that they might try to fight off urges of getting rid of their genitals. Finally, showing cross-dressing habits, withdrawing from social interactions and suffering from anxiety/depression are behaviors displayed by children, adolescents and adults alike.

2. What are the risk factors and causes of the disorder?

-Include the biological, psychological, social and spiritual aspects.

Up to this day, researchers have not found the exact causes for this condition. From the biological perspective, some have accumulated evidence that there’s a correlation between the discrepancy effects of prenatal hormones and prenatal brain development (Cohen-Kettenis and Gooren, 1999) while others have found that the male-to-female transsexual’s hypothalamus was smaller in size than normal males (Zhou et al, 1995).

From a psychological standpoint, gender dysphoria may appear when individual is having difficult relationships with parents who are depressed, neglectful and reproachful and peers who persecute and harass them on a daily basis.

If we look at it from a social viewpoint, it has been reported that male-to-female transsexuals often report over-controlling and rejecting fathers whereas female-to-male often report mothers and fathers that were rejecting and mothers that were overprotective (Meston & Frolich, 2003). A lot of controversy can be extracted from the social aspect of gender dysphoria, especially when engaging in the nature versus nurture debate. In 1965, the case of Janet Reimer of Winnipeg, Canada who gave birth to two twin boys called Bruce and Brian can lead to heated discussions, up to this day. Around two weeks of age, the boys went to the hospital for a routine circumcision intervention. Unfortunately, Bruce’s penis was burnt off during the procedure. At the same time, Dr. John Money, a physician from John Hopkin’s University, was getting an important amount of attention with a study which would prove that gender is acquired through nurture, not nature. So, when the family contacted him for help, he took them under his wing and encouraged the parents to raise Bruce as Brenda (Schillo, 2011). The parents had to keep the secret from their child as long as they could. Unfortunately, Bruce always felt like a boy, despite being brought up as a girl. He was so traumatized by what he had gone through that about 10 years ago, he committed suicide.

Finally, from the outlook of spirituality, gender dysphoria can be induced to a child by his family where spiritual belief in reincarnation can influence the assigned gender at birth by raising child as deceased family member of the opposite sex (Tucker & Keil, 2001).

3. Diagnosis

-Include medical diagnostic exams and assessment tools.

The main tool assessment tool for the diagnosis of gender dysphoria is the DSM-V. The psychiatrist will assess if child, adolescent or adult is suffering from the condition by conducting an interview based on screening questions corresponding to the criteria listed below.

Children: “incongruence with expressed and assigned gender, of at least 6 months, as manifested by at least 6 of the following:

1. Strong desire to be the other gender

2. Boys have strong preference for cross-dressing whereas girls strongly prefer to wear masculine clothing

3. Marked preference for cross-gender roles in child play

4. Preference of toys used by the other gender

5. Strong preference for playmates of the other gender

6. Boys that wish to be girls reject any masculine types of activities whereas in girls it is the opposite

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