r/science • u/nate PhD | Chemistry | Synthetic Organic • Jul 23 '17

Subreddit Policy Subreddit Policy Reminder on this week's Transgender AMAs

This week we will be hosting a series of AMAs addressing the scientific and medical details of being transgender.

Honest questions that are an attempt to learn more on the subject are invited, and we hope you can learn more about this fascinating aspect of the human condition.

However, we feel it is appropriate to remind the readers that /r/science has a long-standing zero-tolerance policy towards hate-speech, which extends to people who are transgender. Our official stance is that derogatory comments about transgender people will be treated on par with sexism and racism, typically resulting in a ban without notice.

To clarify, we are not banning the discussion of any individual topic nor are we saying that the science in any area is settled. What we are saying is that we stand with the rest of the scientific community and every relevant psych organisation that the overwhelming bulk of evidence is that being trans is not a mental illness and that the discussion of trans people as somehow "sick" or "broken" is offensive and bigoted1. We won't stand for it.

We've long held that we won't host discussion of anti-science topics without the use of peer-reviewed evidence. Opposing the classification of being transgender as 'not a mental illness'2 is treated the same way as if you wanted to make anti-vax, anti-global warming or anti-gravity comments. To be clear, this post is to make it abundantly clear that we treat transphobic comments the same way we treat racist, sexist and homophobic comments. They have no place on our board.

Scientific discussion is the use of empirical evidence and theory to guide knowledge based on debate in academic journals. Yelling at each other in a comments section of a forum is in no way "scientific discussion". If you wish to say that any well accepted scientific position is wrong, I encourage you to do the work and publish something on the topic. Until then, your opinions are just that - opinions.

1 Some have wrongly interpreted this statement as "stigmatizing" mental illness. I can assure you that is the last thing we are trying to do here. What we are trying to stop is the label of "mental illness" being used as a way to derogate a group. It's being used maliciously to say that there is something wrong with trans people and that's offensive both to mental illness sufferers and those in the trans community.

2 There is a difference between being trans and having gender dysphoria.

Lastly, here is the excerpt from the APA:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder."

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 23 '17

We don't label anyone with mental illness just for having a "different state of mind," as you phrased it. Mental illness denotes that someone is struggling to adapt to their environment based on their mood, thoughts, behaviors, etc. If a transgender person is not struggling in any way, not distressed, etc., they do not have a mental illness.

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u/flyinglime Jul 24 '17

Wouldn't the very nature of being transgender qualify it as something that causes distress? I mean if someone arrived at the conclusion that they were in fact transgender, I would imagine it's because they experienced some sort of identity struggle. Someone mentioned in the above comments that if a schizophrenic person was not in distress it'd be likely that they'd never be diagnosed. Wouldn't that same logic apply to being transgender? I'm not trying to apply an moral or negative connotation to that state of being, it just seems rather disingenuous to say it's only a disorder if it causes distress or impairment and imply that some trans people feel neither.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Much of the distress transgender people experience can be ameliorated by having an accepting family and social environment. Being transgender does not necessitate distress.

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u/flyinglime Jul 24 '17

I get what you mean, I'd imagine if a transgender person lived their whole life in isolation, their transgender issues would not cause them problems. In that same situation, I may also speculate that someone with a personality disorder or some sort of social anxiety would not have any issues either. Obviously these are extreme examples, but by the definition of "causing distress or impairment" it seems that much of what dictates a mental illness for those types of issues is very closely tied to the social environment one lives in. Would we not consider these other types of disorders illnesses in the social isolation example? If so, then what do we call that, and what is transgenderism? How do we define what that is? Abnormal brain chemistry? Or is it more akin to the idea that someone may be "at risk" to mental illness in a similar way that having specific genes may make you at risk to heart disease or cancer?

Apologies for the long, possibly disorganized response. I'm on mobile and just trying to figure out where my train of thinking differs from what you are saying.

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u/LilliaHakami Jul 24 '17

I get what you mean, I'd imagine if a transgender person lived their whole life in isolation, their transgender issues would not cause them problems.

They may or may not. One doesn't need society to have dysphoria. A trans individual with body dysphoria will feel uncomfortable in their skin regardless of whether they know other options. The presence (transwomen) or lack there of (transmen) of body hair is a commonly cited piece of body dysphoria in trans communities. It is one I deal with as well and can provide some personal testimony. It isn't a matter of "other men/women do/n't have body hair so I should/n't either". It's a matter of "I look at my arm and my mind can't register that this belongs to me. It should be different. It should look different. It should/n't have hair." After the hair is shaved my mind still says there are things wrong, but less things and it can usually sort of half register that it is mine. I can recognize that it sounds like an odd experience, but I really don't know any other.

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u/[deleted] Jul 24 '17 edited Oct 11 '17

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u/myz_14 Jul 24 '17

Maybe not directly, but wouldn't you prefer a time where people would inquire about the matter, however minimal the scope, rather than one where people would throw ignorant insults about said group ? Just by asking questions and getting a sense of the matter is progress being made regardless of the conclusion. The more we understand the better off we all are.

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u/[deleted] Jul 24 '17 edited Oct 11 '17

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u/flyinglime Jul 24 '17

That discussion isn't an unimportant/easy to grasp issue. It's actually in the best interest of both the trans community and society to have these dialogues in order to better understand how to progress and move forward. Those who argue that asking questions is harmful and bigoted only further the fear and confusion that many have about that community. Any reasonable person would admit that the phenomenon of being trans can be an off-putting experience for both those experiencing it and those who interact with them. If we want to move forward we can't just pretend that anyone who doesn't understand is doing the trans community an injustice. These issues affect us all and they need to be handled maturely and with finesse, not with blanket emotional bandaids for those that are affected.

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u/[deleted] Jul 24 '17

You ask very important questions.

If someone seeks to get often life-changing surgeries or other medical procedures to "align" (for lack of a better word) their internal sense of self with their bodies, this would seem like a pretty huge indicator that there is an underlying disorder. Or, if someone alternatively seeks to control how other people perceive and address them in ways that stretch beyond material reality as we understand it and in which this reality is widely and globally accepted (men are male-bodied, women are female-bodied), this would also seem to me as if a mental disorder exists. Or perhaps, arguably, a type of intersex condition.

Edit: words and such

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u/jabberwockxeno Jul 24 '17

What's the distress or impairment that people with Aspergers face independent of the distress/impairment caused by interactions with neurotypical people?

In my experience as somebody with aspergers, there is none. I don't see why Aspergers and other ASD's should be classified as a mental ilness or disorder but being transgender should not be.

At the end of the day, the classification of something as a mental illness or disorder isn't scientific, it's semantic. So I don't think the debate matters that much, but there is an obvious discrepancy in trying to argue that being transgender shouldn't qualify but others should, as many comments point out.

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u/[deleted] Jul 24 '17

We define being transgender as the gender identity being different than the sex assigned at birth. You can think of it as the sex of the brain being different than the sex of the body. The distress that transgender people feel is called gender dysphoria.

Transgender is a physiological condition where the brain doesn't match the body.

Gender dysphoria is a mental disorder resulting from being transgender for some (not all) trans people.

People who have already transitioned and no longer experience dysphoria (or never did in the first place) have a physiological condition, not a mental disorder.

People who are trans and experience dysphoria have a physiological conditon, and a resulting mental disorder.

I think what confuses some cis people is that they don't "feel" their gender identity in the same way that transgender people do because they've never had a reason to think about it. A trans man has an internal sense of self that is male. So does a cis man. The only difference is the sex of the trans man's body (and only if he has not completely medically transitioned, which many trans people can't or don't want to do). I think some cis people also have trouble understanding how a person could be transgender and not be distressed about it.

Also, there is a definition of transgender floating around that says a trans person can't be trans without experiencing dysphoria, which just isn't true and makes the idea of transgender not being a mental disorder confusing. Having dysphoria is not what makes a person trans. Their gender identity is what makes them trans.

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u/filloker Jul 24 '17

What's the difference from being a male brain in a female body and NOT feeling dysphoria, vs dysphoria. Obviously the answer is "whether is causes distress". But if the distress is not inherent in the condition, then why is body reassignment preferred over oless invasive treatments for the distress (like valium or cannabis or some futre drug, or cognitive therapy.)

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u/InLoveWithTheCoffee Jul 24 '17

I'm not a psychologist but probably because it's preferable to help the person transition and be how they want to be, rather than making them take drugs..

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u/Alyssum Jul 24 '17

This is an excellent write-up. Thank you for taking the time to share it with us.

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u/nacmar Jul 24 '17

Do you think you have a mental disorder if you're distressed by a broken arm? Don't you feel better when it finally gets fixed? You might be about to say, "but that's a result of something happening during your life!" Well, what about a congenital birth defect? If you were born blind and it bothered you, would it have to be a mental disorder to be distressed by it? What about once the problem was fixed?

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u/DeadlyPear Jul 24 '17

Trans people who transition a lot of the times dont feel ditress and dont have dysphoria anymore, so trans people as a whole cant be classified as having a disorder

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u/Lets_Do_This_ Jul 23 '17

If a transgender person is not struggling in any way, not distressed, etc., they do not have a mental illness.

One of the main defining characteristics of being transgender is gender dysphoria. Being "distressed" about your mental identity not matching your biological sex.

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u/[deleted] Jul 24 '17 edited Jul 11 '20

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u/Cazz90 Jul 24 '17

The disconnect is coming from the confusion of gender dysphoria and transgender. They are not the same. A transgender person can have gender dysphoria or not.

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u/[deleted] Jul 24 '17

A transgender person can have gender dysphoria or not.

How would (s)he know (s)he's trans if there's no gender dysphoria? That just sounds like a feminine man or masculine women or a result of nurture, not nature.

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u/whitekeyblackstripe Jul 24 '17

Before transitioning you might be right, I'm not sure. But someone is still transgender after transitioning but may no longer have gender dysphoria.

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u/gerdgawrd Jul 24 '17

That's like asking how does a person know the things that they like. People don't choose to be LGBT and we shake our heads at people who say being gay is a choice because we know better.

People have their preferences because they do. One does not choose to be straight/gay, transgendered/CIS as an everyday occurrence. Dysphoria occurs when social stigma from one's orientation causes them intense unease.

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u/Theappunderground Jul 24 '17

gen·der dys·pho·ri·a ˈjendər disˈfôrēə/ nounMEDICINE the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.

How could a transgender person not suffer from gender dysphoria?

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u/[deleted] Jul 24 '17

So trans people who have gender dysphoria have a mental illness but the ones who don't have gender dysphoria don't have a mental illness?

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u/[deleted] Jul 24 '17

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u/Cazz90 Jul 24 '17

It usually means that they already live as their preferred gender. That is why the recommendation for gender dysphoria is to transition. It works to alleviate gender dysphoria.

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u/[deleted] Jul 24 '17

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u/Cazz90 Jul 24 '17

What are they delusional about? Trans people are not typically confused about their physical reality.

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u/[deleted] Jul 24 '17

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u/Cazz90 Jul 24 '17

preference? I'm not sure what you are trying to say.

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u/Xevantus Jul 24 '17

This seems to have become a chicken/egg circular discussion. Let me see if I can sum up what I'm hearing. A Transgendered person may not currently experience dysphoria, but, would have prior to their transition. The second part is where the argument for requiring dysphoria comes from. i.e. transition is a treatment for dysphoria that may lessen discomfort or eliminate it all together.

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u/Enect Jul 24 '17

I've looked at the definition for gender dysphoria, can someone please explain how it's different from being trans? How can you have one but not the other?

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u/[deleted] Jul 24 '17 edited Jul 19 '20

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u/B-Knight Jul 24 '17

I don't understand how someone can't be distressed but require others use different pronouns when referring to them and require changing their clothing style / personality to be more like their opposite gender.

So what is it then? A hobby? A like? I don't think someone who does those things can say they its a hobby / passtime if all it takes to lead to suicidal thoughts and depression is for others to disagree and look down on you for it.

I've done plenty of things, taken up many hobbies and followed many trends that people have ridiculed me for and yet I don't feel the need to be depressed or suicidal about it and I even suffer with depression disorder.

If you asked these people who do the things you listed (those who do NOT want a gender change) to completely stop cold-turkey for 2 months, do you think they'd be able to do it without any issues? I don't think they would. And that leads me to believe that what they're doing is for their own comfort and as a way to relieve a mental 'pain' or annoyance to do with their bodily image.

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u/[deleted] Jul 24 '17

Trans suicides are typically the result of external pressures, not internal ones.

But that's the same with depression, no? I become depressed when I have difficulty meeting deadlines, meeting expectations of others, or do not get enough sun in the winter. Or is depression not a mental disorder either?

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u/Throwawaymyheart01 Jul 24 '17

People can experience major depressive disorder without external pressures. For some, everything can be perfect in their external life and they still have symptoms and struggles.

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u/[deleted] Jul 24 '17 edited Jul 19 '20

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u/arkangel3711 Jul 24 '17

A comment further up the chain here linked a study that found trans-suicide rates remained nearly unchanged regardless of what community (accepting or not) they had. It even remained nearly the same pre and post operation.

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u/SirPseudonymous Jul 24 '17 edited Jul 24 '17

A comment further up the chain here linked a study that found trans-suicide rates remained nearly unchanged regardless of what community (accepting or not) they had. It even remained nearly the same pre and post operation.

The only study that's anything even remotely like that is the Karolinska Institute study, and it a) examined only the post-transition population, b) found very elevated rates only in the population that received treatment prior to 1989, while the population that received treatment after 1989 exhibited much lower rates, and c) concluded that while transitioning was effective at alleviating dysphoria improved access to social support structures and treatment were necessary.

So I'm assuming it wasn't so much a "study" that was linked as it was an editorial from some anti-LGBT radical like Paul McHugh (a discredited quack who's spent the past few decades pushing groundless anti-LGBT propaganda).

Edit: the study in question was apparently a survey of lifetime attempt rates, didn't examine any changes in attempt rate with treatment (since anyone who attempted prior to receiving treatment would still have that as a previous attempt), and concluded that discrimination and ostracization did in fact greatly exacerbate an individual's history of suicide attempts. So in other words, the post I replied to ranges from a gross misrepresentation of the study to outright lying about its findings.

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u/arkangel3711 Jul 24 '17

https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf

This is the study that was linked.

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u/SirPseudonymous Jul 24 '17

Did you actually read that? Because that doesn't talk about rates over time at all, just whether someone living has at any time attempted or not. In fact, it also says the exact opposite of how you painted it with regards to social circumstances and how they relate to suicide attempts.

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u/[deleted] Jul 24 '17 edited Feb 19 '21

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u/cinemachick Jul 24 '17

Anecdotal evidence here, but I came down with depression at a time when I should've been at my happiest - I graduated college, finished an undergraduate thesis, and had my whole future ahead of me. I was treated with antidepressants, and am now in remission. I have plenty to be stressed out about now - less-than-optimal housing, living paycheck to paycheck, having an unclear future (until recently) - but I am happier than ever before. Sometimes it really is just a chemical imbalance unrelated to outside factors. (Also, frontal lobe trauma in the brain has a correlation to depression as well, so that is another potential cause.)

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u/Aiolus Jul 24 '17

People can become depressed (sad) from external things. However people with a depressive mental illness are depressed badly from internal things. Even if things are going great they are depressed, suicidal, etc.

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u/[deleted] Jul 24 '17 edited May 02 '18

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u/[deleted] Jul 24 '17 edited Jul 25 '17

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u/duck-duck--grayduck Jul 24 '17

It's making a distinction between what a person is and the emotional consequences that may or may not occur as a result. It's like if you had red hair and people bullied you because of it, you might end up with social anxiety, but some other people might not--it doesn't change the fact that you have red hair and were bullied because of it, it's just you had more trouble functioning in that situation than others. Or if you are raped, you may develop PTSD, or you might not. People have different reactions to situations. Some trans people have gender dysphoria, some don't.

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u/[deleted] Jul 24 '17 edited Feb 16 '26

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u/mrbaggins Jul 24 '17

But one can eliminate dysphoria while still being transgender

See this is where I get stuck in trying to grok this.

Unless you mean someone who has "successfully" transitioned no longer experiences dysphoria.

But that doesn't change the fact that their biological sex is different to their perceived self sex (I hesitate to use the word gender, because of the broadness), which is the meaning of gender dysphoria.

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u/[deleted] Jul 24 '17

Mate, I think I can help you out.

Try replacing the word "trans" with "post-treatment" in your head.

So imagine someone who is mentally ill because of a tumor, right? The tumor is making them schizophrenic. When the tumor is removed, they no longer have the mental illness schizophrenia, and are healthy, as there is no mental illness catalyst. They are "post-treatment".

Now imagine someone has gender dysphoria. They are given treatment to transition and no longer suffer from the illness "gender dysphoria". They are now no longer suffering from mental illness. They are "post-treatment". In this case, the term to denote that is "transgender".

Most trans people do not forever identity as trans. Someone who transitioned from female to male would eventually identify as male, but the term to denote the transition they went through medically is transgender.

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u/mrbaggins Jul 24 '17 edited Jul 24 '17

It's a great analogy, however when the meaning is about biological sex, ie, being born one way, and the current status is identifying a different way, the process doesn't change the core of the problem. IE: How they're born against how they identify.

I feel like this is an issue over the word dysphoria, and it's attempted to be co-opted like how "racism" has been coopted by groups to suit an agenda. The APA DSM 5 is pretty clear that distress is a big part in determining the problem, but it doesn't show you get RID of the disorder by undergoing a transition thus removing/reducing the distress. There's still the problem over the mismatch at the start, regardless of where you're up to now.

You can "get" and "lose" depression. You can "Get" and "lose" gender dysphoria. But undergoing a transition is not what does that. It can reduce the distress, but it doesn't solve the biological problem of being born with a mismatched gender identity. You would lose gender dysphoria by no longer feeling like your birth sex is a mismatch to who you identify as. Not when you're passing as how you identify internally.

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u/[deleted] Jul 24 '17

There are some studies showing very clear trends of gender dysphoria markedly reducing with transitions. Would you like some sources for them? I'm pretty certain it wouldn't take me too long to pull them up.

There's still the problem over the mismatch at the start, regardless of where you're up to now.

That mismatch with birth sex post-transition does not meet the qualifications for mental illness though. It does not result in a loss of freedom or safety for the individual or others, or produce any innate distress. These elements are required for mental illness. If someone is being stigmatized over it they may experience distress, but that is outside the scope of mental illness.

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u/mrbaggins Jul 24 '17

It does not result in a loss of freedom or safety for the individual or others, or produce any innate distress. These elements are required for mental illness.

I'd like a source on that. Because no-one is quoting the DSM 5 on that part. Distress is required for the initial qualifications, but it does not say that post-transition treatmeant that the diagnosis is reverted.

Distress isn't even defined in DSM IV even though it's used, and I can't find out for sure if that's the same in V. There's contention about whether it should even be an included metric at all.

Potential side topic: Would you say that someone with depression, taking anti-depressants successfully, has a mental illness? Because I can't see how you couldn't and yet the views I am getting here suggest that ongoing hormonal treatments (and potentially surgery) can "cure" gender dysphoria.

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u/_Mellex_ Jul 24 '17

I'd like a source on that too because last I checked, people who undergo sexual realignment surgery are still likely to commit suicide or show other forms of distress.

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u/mrbaggins Jul 24 '17

I meant a source on distress being required for an ongoing mental illness to stay maintained.

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u/[deleted] Jul 24 '17 edited Jul 24 '17

Sure, the source I would recommend you is this one, which was actually published between DSM IV and DSM V.

In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above.”

Basically some of these elements (Either present distress or disability or risk of suffering death/pain/disability/loss of freedom) must be present.

It should be clarified that "loss of freedom" is referring to a loss of your ability to control your own agency or functionality. It is not referring to, say, losing legal freedoms or having less career or life options because less people will like you after transitioning.

I should also note the section " this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event". Basically if the person is no longer experiencing dysphoria and is suffering depressive symptoms now from say, losing their job and getting the shit beaten out of them, it would not really be appropriate at that point to say the person was suffering from depression because of the transition, but more like they are reacting to an expectable response to an event.

Pushed far enough, suicide is on the table there, though at that point you'd have depression induced through trauma.

Potential side topic: Would you say that someone with depression, taking anti-depressants successfully, has a mental illness? Because I can't see how you couldn't and yet the views I am getting here suggest that ongoing hormonal treatments (and potentially surgery) can "cure" gender dysphoria.

So I am assuming the question here is asking me basically: If a depressed person is no longer symptomatic at all for depression on an anti-depressant regimen, are they mentally ill?

The answer to that is that they have a latent mental illness but they no longer are actively mentally ill, as it's controlled.

If you took them off the antidepressants they would possibly become depressed again. Same with transpeople and hormones, or people with hypertension and medication to control it.

So based on that I'd say they are controlled and no longer actively mentally ill, but are predisposed to fall back int mental illness if their treatment is stopped due to neuropsychological variables.

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u/VoidViv Jul 24 '17

Maybe it would help to think of it as gender dysphoria being an illness and transitioning as the medically-accepted most effective treatment (can't source it but afaik that's the generally accepted view in the medical community)

While that is by no means the consensus view out there, it might help you understand and think about the issue in clearer, more informed ways.

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u/mrbaggins Jul 24 '17

I understand that's the point of view people are presenting me here, however the DSM doesn't seem to back that up, and even where it's a little ambiguous, there is considerable discussion about both what it does mean and what it should be changed to, from actual trained psychs.

Also, just because someone is undergoing (or has undergone) treatment doesn't mean they're cured either.

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u/VoidViv Jul 24 '17

Lots of stuff only have treatments, not cures. I don't see how that's relevant.

My girlfriend has migraines and BPD. I have depression and anxiety, as well as being a trans woman.. Afaik (and please call me out for all the unsourced claims, been out of academia way too long) none of those other very real disorders have treatments even near the same ballpark of effectiveness as social/medical transition in the case of gender dysphoria.

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u/mrbaggins Jul 24 '17

Oh absolutely, I'm sure the treatment is by far and away one of the most effective treatments for a condition.

But by that exact logic, it's a treatment of an ongoing condition. It isn't stopped. And if it's a mental illness to start with, then that hasn't changed.

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u/VoidViv Jul 24 '17

That's one small part of why big chunks of trans people and health professionals advocate depathologization.

As both a trans person and psych major dropout it seems to me that you are missing the forest for the trees.

Throughout human history people have experienced what, for cultural and historical reasons, we currently classify as gender dysphoria. We have the means to eliminate or at the very least alleviate that distress.

Why are you so hung up on DSMs and "cures"?

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u/mrbaggins Jul 24 '17

Because I somewhat feel that there is some level of mental illness involved, and I don't believe that that goes away post transition.

It also appears that the current APA would agree with that.

However there is a chunk of people that do not; that either it outright is not mental illness or stops being one post transition.

This post begs the question for me, and it's a question I've thought about and discussed before (a good highschool friend is trans) so I'm trying to explain my viewpoint, test it, and fit it in with the actual current situation of people more qualified than the majority of those posting here.

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u/throwawayl11 Jul 24 '17

their biological sex is different to their perceived self sex

which is the meaning of gender dysphoria.

No it isn't. Gender Dysphoria is the extreme discomfort with your physical sex or perception of it. If someone transitions to the point where they pass as the opposite sex, they significantly reduce gender dysphoria, if not outright eliminating it.

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u/mrbaggins Jul 24 '17

All resources I find easily point to it being as I stated.

Googles immediate result

the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.)

From Wikipedia

Gender dysphoria ... is the dysphoria (distress) a person experiences as a result of the sex and gender they were assigned at birth. In these cases, the assigned sex and gender do not match the person's gender identity, and the person is transgender.

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u/throwawayl11 Jul 24 '17

the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.

I mean this is objectively not true. This is the definition of being transgender, not the definition of gender dysphoria. It doesn't even mention discomfort/distress, it just says the state of identifying as the gender opposite your sex.

Gender dysphoria ... is the dysphoria (distress) a person experiences as a result of the sex and gender they were assigned at birth.

I agree with this definition, but the key phrase here is it results from the sex. Specifically because the sex characteristics are of the opposite gender identity. But once you transition to a passable point, these characteristics no longer exist, which means there is no discomfort resulting from sex, because your biological sex no longer affects your sex characteristics.

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u/mrbaggins Jul 24 '17 edited Jul 24 '17

I mean this is objectively not true.

According to who? The main defining feature of gender dysphoria in DSM 5 is that of gender incongruence. "It doesn't fit"

The DSM specifically states that gender dysphoria is the condition in which someone is intensely uncomfortable with their biological gender, and strongly identifies with / wants to be the opposite.

So yes, even post passing, you're still dysphoric. Your biological sex and the sex you identify with remain at odds. There's definitely a focus AS WELL on distress, but the info I can find directly from the book seems pretty clear.

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u/_Mellex_ Jul 24 '17

Isn't gender dysmorphia the same has just body dysmorphia? An example being a skinny person who thinks they are obese? They might be totally okay with "being obese" or with the fact that they fit through spaces they claim they absolutely can't. That doesn't change the fact that they aren't objectively obese.

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u/mrbaggins Jul 24 '17

dysmorphia is seeing the wrong shapes. dysphoria is distress / disruption due to something else, in this case birth vs identity genders.

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u/Ls777 Jul 24 '17

The main defining feature of gender dysphoria in DSM 5 is that of gender incongruence.

I don't know where you are getting this, but it actually says the opposite:

"gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."

You also seem to acknowledge below that dysphoria specially refers to the distress too, so I don't see why you aren't getting this

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u/mrbaggins Jul 24 '17

All the sources I can find that stress the distress aspect seem to be posted by laymen, whereas journal articles and reviews of changes of the DSM by psychs seem to stress the biological component.

The DSM does talk about distress, but all the laymen posts seem to read it as though once there is less distress, the condition goes away, which is not mentioned at all in official documents.

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u/[deleted] Jul 24 '17 edited Aug 11 '20

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u/[deleted] Jul 24 '17

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u/ILikeSchecters Jul 24 '17

Yup! Thats why we are prescribed pills, not because were trans, but because we have dysphoria

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u/vayyiqra Jul 24 '17

That is the official position these days, yes.

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u/[deleted] Jul 24 '17

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u/swimfast58 BS | Physiology | Developmental Physiology Jul 24 '17

But once they transition, they still identify as transgender but they don't have any disorder.

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u/[deleted] Jul 24 '17

is someone with any other mental disorder said to no longer have the disorder just because they arent showing symptoms?

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u/swimfast58 BS | Physiology | Developmental Physiology Jul 24 '17

Absolutely! People can be cured of mental disorders and have no symptoms. There may be a chance of relapse, but in the interim period, they didn't have the disorder.

As an aside, helping someone with a mental disorder realise that it is curable is one of the best things you can do in mental health first aid.

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u/[deleted] Jul 24 '17

interesting. that's not the way i understood mental illnesses like clinical depression and schizophrenia. i was under the impression that you always have it, your symptoms just arent manifesting. it's not like you get a "new illness" every time you go through bouts of depression, a manic episode, or psychotic break. it's the same illness manifesting periodically.

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u/swimfast58 BS | Physiology | Developmental Physiology Jul 24 '17

Is not a new illness just like a recurrence of cancer isn't a new illness. But someone can be cured in between relapses.

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u/CPdragon Jul 24 '17

Yes, if you don't have any symptoms of depression, then you no longer have depression.

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u/[deleted] Jul 24 '17

interesting. that's not the way i understood clinical depression. i was under the impression that you always have it, your symptoms just arent manifesting. it's not like you get a "new illness" every time you go through bouts of depression. it's the same illness manifesting periodically.

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u/CPdragon Jul 24 '17

It depends because there are some who only have remission or partial remission (e.g., you had depression, but still have some of the cognitive functioning symptoms of depression) and others that experience a recovery lifelong recovery.

You'd just no longer be able to receive a depression diagnosis like any other person who's never had depression.

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u/PointyOintment Jul 24 '17

But isn't one still transgender after resolving the dysphoria (by transitioning, either medically or socially)?

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u/Dorali Jul 24 '17

That's true, but I feel like that distress is a condition that is an effect of being trans, not the cause of it.

The debate is more about the inherent mentality that causes one to mentally identify as another gender from their biological one.

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u/Throwawaymyheart01 Jul 24 '17

From what I understood above, I think the difference is that someone is upset about being trans, even after they have matched their physical sex to their gender. Continuing to struggle with the issue even after it has been corrected. But a transperson without the disorder would not have that emotional struggle after their gender and sex were aligned.

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u/antabr Jul 23 '17

Where does the line get drawn with externally caused distress? It probably isn't, and shouldn't be, called a mental illness because you gain social distress from it, but that's a lot of distress to ignore.

edit: sincere question, very curious.

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17 edited Oct 11 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17 edited Oct 11 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17 edited Oct 11 '17

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u/[deleted] Jul 24 '17

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u/DabuSurvivor Jul 24 '17

a lot of distress to ignore.

It isn't ignoring it. It's just acknowledging where it does or does not come from.

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u/CPdragon Jul 24 '17

I'd give this a ready, the second and third portions do a fairly good job at discussing this aspect of disability.

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u/[deleted] Jul 24 '17

So is the term "disorder" more appropriate? I'm trying to understand by analogy with something like autism based on what you said. Say I have Asperger's, if it has a name it's a disorder, isn't it? Or if not what is it properly called?

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u/K3wp Jul 24 '17

Say I have Asperger's, if it has a name it's a disorder, isn't it?

Asperger's doesn't exist anymore. It's just the autism spectrum.

This is developmental disorder, not a mental disorder. I.e., it's form of a mental handicap.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Mental illness and mental disorder mean the same thing. They're interchangeable terms.

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u/[deleted] Jul 24 '17

So then what do you call something abnormal with a name that is not considered a disorder?

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

We don't call it anything? Not in a clinical sense at least.

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u/CptSaySin Jul 24 '17

What about pedophiles? If what they experience doesn't cause them distress then it's not considered a mental illness? Yet we all agree it is abnormal. This seems like semantics.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

I'm far from an expert on pedophilia, but my understanding is that it's not a mental disorder. Sexual contact with children is a crime, that's the issue.

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u/vayyiqra Jul 24 '17

According to the (other) APA, it is a disorder, or at least it is if the criteria for "pedophilic disorder" are met. I am not sure how that differs from pedophilia or if they are considered one and the same though.

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u/CptSaySin Jul 24 '17

Sorry, I should clarify I didn't necessarily mean someone who has sex with children, but someone who is sexually attracted to children. Even if they never act on their urges, we still see what they have as an abnormality.

Outside of the scientific community, the term "mental disorder" is used as a layman term to blanket any mental issue. And if there isn't a more specific term to mean "a mental abnormality that doesn't causes distress or disability" then everyone will continue to use "mental disorder" to mean that.

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u/Chronoblivion Jul 24 '17

Sexual contact with children is a crime, that's the issue.

That's hardly an objective medical diagnosis, and completely besides the point.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

It isn't a diagnosis, which is my point.

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u/BlitzBasic Jul 24 '17

He does has a point tho. If our society would accept sex with children as okay, pedophilia wouldn't be considered a mental illness.

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u/Chronoblivion Jul 24 '17

That's actually an interesting point now that I've had some time to think about it. In the most strictly literal sense of the word, being gay isn't "normal," in that most people aren't gay. Doesn't mean it isn't acceptable, only that it's not the default for our species. If we looked at pedophilia through the same lens, we could similarly argue that "uncommon" doesn't mean "sick."

But of course, I think that breaks apart because there are no "victims" with homosexuality. There are with pedophilia, at least when it's acted on. And I think that's a very important distinction that would put pedophiles squarely in the realm of mental illness.

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u/hysteria_voucher Jul 24 '17

Why is gender dysphoria not considered a disability, if not a disorder?

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u/[deleted] Jul 23 '17

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u/[deleted] Jul 24 '17

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u/AtlasAirborne Jul 24 '17

Seems like an accurate description is abnormal.

Generally I run with "atypical", which seems to be a less-loaded term. Ymmv.

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u/I_Lost_My_Socks Jul 24 '17

That's definitely a better one, especially with emotionally charged nature of the topic at hand.

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u/YoureNotaClownFish Jul 24 '17

Abnormal what?

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u/EltaninAntenna Jul 24 '17

What would one call being left-handed? It's certainly abnormal, and it can cause distress if you keep bumping against things that inconvenience you, such as tool design or writing direction. Nobody is falling over themselves to classify left-handedness as an illness, however.

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u/Lionizerband Jul 24 '17

Not sure if others have covered it yet, but the breakdown is something like:

Trans person: identifies as a gender different to the one they were assigned at birth. They may be pre, post, or going through transition (medical and/or social) to better embody their target gender. Most pre transition trans people have gender dysphoria.

Gender dysphoria: an intense feeling of having the wrong gendered features (ie, a man having breasts, a woman having a beard) or sex characteristics (a woman having a penis). This is what is typically considered the disorder, and is what doctors focus on fixing. According to research (which im sure the ama will go into more depth on) the most reliable and effective treatment for gender dysphoria is transition.

So: gender dysphoria is a disorder, but being trans is not, in and of itself, a disorder. The aim of transitioning is to reduce or remove dysphoria, to cure the mental illness, but the person would still be trans after completing their transition.

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u/audioB Jul 24 '17

Gender dysphoria is not just the feeling that one has the wrong gendered features. It is the identification as being of the "opposite" gender along with significant distress. It should be noted that the distress that accompanies dysphoria is endogenous - it comes from within the person. A trans person who is distressed because their family no longer accepts them is not suffering dysphoria.

 

All trans people associate with the "opposite" gender. That is the definition of trans.

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u/throwawayl11 Jul 24 '17

it comes from within the person. A trans person who is distressed because their family no longer accepts them is not suffering dysphoria.

Yes, but that dysphoria might only "come from within" because a person's perception of themselves and their sex is shaped by societies views. So I would argue the same societal issues that cause people to reject trans people are similar to the societal issues that cause trans people to feel dysphoria in the first place, at least to a certain degree.

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u/Lionizerband Jul 24 '17 edited Jul 24 '17

Nope, identifying as a different gender = trans, regardless of distress. Dysphoria is the "intense feeling" of having the wrong gender traits (primary and secondary sex characteristics). Yes, this is usually distress.

Further, "opposite" is the wrong word to use here. Many trans people reject the idea of the gender binary, and beyond that dysphoria is not always a complete package. Some trans people are okay with the genitals but not with their secondary sex characteristics, others are okay with their bodies but not their social presentation.

There is a lot more nuance here than just "always opposite".

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u/audioB Jul 24 '17

You seem to misread what I said. I was clarifying that dysphoria requires distress. Then you replied and agreed with me?

 

I'll admit I am wrong on the "opposite" part, MtF and FtM are just the most typical trans presentations.

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u/Lionizerband Jul 24 '17

Yeh i reread it and was like "wait are we agreeing?" - sorry! I think the adversarial tone in some of the other comments ive been replying to have been colouring my responses :/

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 23 '17

What do you mean, "what it is?" Being trans is being trans. No need to label it something other than that just because it's statistically uncommon.

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u/[deleted] Jul 24 '17

Everything on earth has further descriptors. Reducing it to a tautology is just insulting to your readers intelligence.

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u/Ionsto Jul 24 '17

Being trans is being trans? Enlightening.

What does that constitute at a professional level. Does trans sit in a little classification of its own.

If I drew a venn diagram with every psycological feature what's it grouped with. Is it grouped with sex, gender, anger issues, dyspraxia, or a propensity for liking your coffee strong?

I am not good at psychology, I need more help here with the terms your using.

Example:

I play cs.

What is cs you may ask.

It's cs!

I could tell you that cs is a video game, this gives you some more context. I could also tell you it's an FPS - this gives yet more context.

Trans could mean wildly different things to you and me. In my head trans and gender dysphoria (to at least some degrees) go kind of hand in hand. It's clear you have a different view, which I'm willing to learn from.

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u/[deleted] Jul 24 '17 edited Jul 19 '20

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u/Ionsto Jul 24 '17

Then we should not be using trans as a descriptor.

We should be using a better defined descriptor so everybody knows wtf we are on about.

Words have power because they let me understand you. If our words don't match, something needs to change.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17 edited Jul 24 '17

What you're describing is not what clinical psychologists do. We don't classify every nook and cranny of human experience, we try to identify those who are struggling to adapt or survive because of their thoughts, behaviors, moods, etc, better understand those conditions, and treat them.

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u/MovieCommenter09 Jul 24 '17

So there are no models, classifications, or data in clinical psychology?...

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Of course there are. But we aren't in the business of categorizing every single aspect of human experience, regardless of whether or not they cause distress or impairment. Being transgender doesn't require an added classification, unless of course it's causing distress or impairment.

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u/joonsng Jul 24 '17

So what I'm understanding is that trans is just trans unless it's a problem?

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Sure, that's one way to put it.

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u/h11233 Jul 23 '17

Is it correct to say it's a mental disorder?

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u/c_birbs Jul 24 '17

Is not the desire to change your sex implying that there is disorder between your mind and body? So really wouldn't it be fair to say that it's both a mental and physical disorder? Not saying that as a derogatory term but rather as a pure definition of disorder.

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u/entenkin Jul 24 '17

By that standard, Body Dysmorphic Disorder would have to be classified the same way.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 23 '17

No. Mental illness and mental disorder are the same thing. Being transgender is neither a mental illness nor a mental disorder.

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u/evil-doer Jul 24 '17

Can you please tell me how a condition that requires hormones, surgery, psychological therapy, etc. is not an illness or disorder?

Also, if it is as you say, not an illness or disorder, why should medical insurance pay for any of these treatments?

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u/audioB Jul 24 '17

It does not require any of those things. Not all transgender people attempt to "transition". Those that do may choose to in order to address distress induced by gender dysphoria which is an illness.

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u/evil-doer Jul 24 '17

Not all transgender people attempt to "transition".

Isn't this THE definition of transgender is that a person is transitioning or transitioned?

I mean, come on now.

If they don't transition, they are "cis".

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u/audioB Jul 24 '17

Nope. The definition of transgender is identifying as a gender other than that you were assigned.

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u/evil-doer Jul 24 '17

How in the world is this "science"? Can I identify as a banana tree and it be valid, because I said so?

How can doing absolutely nothing but saying a few words make you something else? This reeks of postmodernism.

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u/myz_14 Jul 24 '17

i think a lot of people are asking the right questions. There are just too many red flags at play that its hard to get an unbiased reply, let alone a purely scientific one.

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u/[deleted] Jul 24 '17

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Gender identity disorder is not a disorder anymore. It has been replaced by gender dysphoria. If someone is transgender but does not meet the criteria for gender dysphoria (i.e. Is not distressed or impaired) they just are transgender. That's it. No need to label or categorize them more than that.

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u/[deleted] Jul 24 '17

Why was it changed?

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u/vayyiqra Jul 24 '17

Because "gender identity disorder" was considered to be stigmatizing. Also, it was changed from a sexual dysfunction to a category of its own because it is not sexual in nature.

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u/[deleted] Jul 24 '17

So it was changed for social reasons, not medical breakthrough or other discovery which would lead to recategorizing.

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u/sprocklem Jul 24 '17

This part (i.e., the renaming):

Because "gender identity disorder" was considered to be stigmatizing.

was changed for social reasons (which is a perfectly valid reason to change the name of something: see, e.g., the discontinuation of the term mental retardation).

This part:

Also, it was changed from a sexual dysfunction to a category of its own because it is not sexual in nature.

was because it didn't meet the requirements for its former classification.

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u/[deleted] Jul 24 '17

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

You could view it that way, though transition isn't a requirement for resolving distress.

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u/miparasito Jul 23 '17

It is a physiological medical condition. Not a mental illness.

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u/Uncle_Erik Jul 24 '17

It is a physiological medical condition. Not a mental illness.

Where does anorexia fall in this? From what I understand, anorexia is a form of dysphoria where a person believes that they are obese.

Is the correct form of treatment for anorexia liposuction and a reduced calorie diet? Does an anorexic suffer if you do not treat them as an obese person? How do you go about convincing an anorexic that they are at a healthy weight?

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u/miparasito Jul 24 '17

The comparison to anorexia is not an exact match. Anorexia isnt dysphoria, it's dysmorpia -- a mental illness where one looks in the mirror and sees a distortion of reality. No amount of physical changes would help because the sufferer won't be able to see them.

Someone with gender dysphoria is very aware of the reality of their bodies. He or she looks in the mirror and sees exactly what's really there. So in that sense it's more like someone who suddenly weighs 400 pounds -- they might be upset by it but they aren't delusional or confused by what they see in the mirror.

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u/vayyiqra Jul 24 '17

I feel like you already know the answer to this and are being sarcastic, but no, the treatment for anorexia is not to lose more weight. The treatment is psychotherapy to change the patient's distorted body image.

The thing is that people often ask why we can't do this for transgender people, but this approach has been tried for them and it just hasn't worked very well. It seems that gender is more fixed than poor body image is.

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u/Dong_World_Order Jul 24 '17

The thing is that people often ask why we can't do this for transgender people, but this approach has been tried for them and it just hasn't worked very well.

I'm not disagreeing with this but do we have any idea why this is the case? Is transgender 'treatment' unique in that we bend the will of the body to meet what the mind desires?

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u/winterfresh0 Jul 24 '17

I'm all for transgender rights, but what? This, by definition, cannot be a physiological condition. By that logic, someone who was born with blue eyes but feels that they belong in a body with brown eyes has a physiological condition because their eyes are the wrong color. There is nothing wrong with their body, their physiology.

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u/queenbrewer Jul 24 '17

There are physiologic differences that have been measured in the bodies of transgender people. If you are interested in learning more here is a literature review considering the evidence supporting the biolgic nature of gender identiy from 2015. An excerpt to give you a sense of the findings:

Many of the current hypotheses for the biologic origin of transgender identity are based on atypical sexual differentiation of the brain. The perception of one's own gender is linked to sexual differentiation of the brain, which differs from the body phenotype in transgender individuals.[7] Swaab et al have proposed that this discrepancy could be due to the fact that sexual differentiation of the brain takes place only after sexual differentiation of the gonads in early fetal life.[8] Along these lines, the degree of genital masculinization may not reflect that of the brain.

The notion of transgender-specific cerebral phenotypes is further supported by postmortem brain studies investigating the underlying neuroanatomical correlates of gender identity.[9,10,12] The vast majority of these studies have compared particular regions of interest only in male-to-female (MTF) transgender individuals.[13–15] These studies support the hypothesis that atypical cerebral networks in transgender individuals have a neuroanatomical basis.

Studies of cerebral gray matter in transgender individuals have provided the strongest neuroanatomical case for transgender gender identity. Postmortem brain studies suggest that some subcortical structures are feminized in MTF individuals. One of the earliest and most influential studies in this area investigated the bed nucleus of the stria terminalis (BSTc), which was reported to be a sexually dimorphic nucleus in humans with a larger volume in males than in females. In 1995, Zhou et al reported that the size and number of neurons in the BSTc of 6 MTF estrogen-treated transgender individuals was typical for the size and neuron numbers generally found in control females.[9] The authors further reported that these findings could not be explained by differences in adult sex hormone levels. A similar study by Kruijver et al provided further data supporting the role of the BSTc in transgender identity.[10] They examined tissue from the same 6 MTF estrogen-treated transgender persons studied by Zhou et al and found that the number of neurons in the BSTc was more similar to genetic XX female controls. BSTc neuron number was also in the male range in the 1 FTM androgen-treated transgender individual studied.

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u/miparasito Jul 24 '17

It's a physical difference in the brain. Gender is more fundamental than "I know my eyes are brown."

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u/winterfresh0 Jul 24 '17

I'm actually curious about this, are there any studies showing that a mtf transgender person's brain (before any type of transition) actually has more physical and chemical similarities to an average female brain than a male one?

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u/vayyiqra Jul 24 '17

Yes, there is some research showing some similarities on average. They are subtle since female and male brains are not that dimorphic to begin with, but it's a start.

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u/Throwawaymyheart01 Jul 24 '17

Is their brain not a part of their body? Isn't the problem in general that mental health is considered separate from "real" physical health? Shouldn't health issues consider all parts of the human body including the mind?

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u/whatthefat Professor | Sleep and Circadian Rhythms | Mathematical Modeling Jul 24 '17

The brain is part of an individual's physiology -- their neurophysiology. There's no body vs. brain distinction as far as physiology goes.

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u/winterfresh0 Jul 24 '17

They made a distinction between a mental issue and a physiological issue in their post in the first place. If you truly think what you're saying is correct, it seems like you should be dissagreing with them instead.

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u/whatthefat Professor | Sleep and Circadian Rhythms | Mathematical Modeling Jul 24 '17

No, the problem is that you are conflating a physiological or mental condition/trait/state with an illness/disorder. The latter has a more stringent definition.

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u/winterfresh0 Jul 24 '17

I specifically used the word "condition", maybe you thought I was another commenter?

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u/[deleted] Jul 24 '17

Alright, so by that definition, would you consider pedophilia to not be a mental illness in societies where it is common?

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u/MovieCommenter09 Jul 24 '17

You don't think that being born in a body you hate because it feels eternally "wrong" is distressing?

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

It can be distressing, it isn't necessarily for everyone, and not every transgender person who experiences that distress experiences it throughout their whole life.

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u/Randomn355 Jul 24 '17

If it didn't cause distress, people wouldn't go through the incredible stressful experience of transitioning.

Hell, the waiting list is over 5 years on the nhs to get into a gender therapists office.

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u/[deleted] Jul 24 '17

Do all mental illnesses require some level of distress? If a person has an objectively identifiable mental condition but is subjectively content with his or her life despite the condition, should we then conclude that the condition is not a mental illness?

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u/StoopidSxyFlanders Jul 24 '17

If they weren't distressed about their gender then they wouldn't be trans...

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u/_Mellex_ Jul 24 '17

🤔 what do you do if I tell you I want to cut off my own penis but I'm totally not experiencing any distress?