什么是性别认同障碍？——“我生理上是男性 但我认为我全身心本应该是女性”
What Is Gender Dysphoria?
By Robert Longley
:max_bytes(150000):strip_icc():format(webp)/woman-standing-in-rectangular-opening-of-coloured-wall-816813852-5af34464a474be003757ae2a.jpg)
(Image: © Klaus Vedfelt / Getty Images)
The term gender dysphoria describes a strong feeling that one’s actual gender is different from the biological sex assigned to them at birth. Gender dysphoric persons born with male genitalia and physical characteristics may strongly feel they are actually females, while those born with female genitalia and physical characteristics may strongly feel they are actually males. Dysphoria is defined as a profound state of unease or dissatisfaction.
Key Takeaways: Gender Dysphoria
Gender dysphoria is a strong feeling that one’s actual gender is different from the biological sex assigned at birth.
Children, adolescents, and adults may experience gender dysphoria.
Gender dysphoria is not a mental illness.
Gender dysphoria has no bearing on a person’s sexual preference.
Gender dysphoria was called “gender identity disorder” until 2013.
Due to their differences from “gender norms," dysphoric people face significant challenges to gaining equality and social acceptance.
Today, there is evidence that society is becoming more accepting of gender dysphoric people.
Gender dysphoria was formerly called “gender identity disorder.” However, this suggested that gender confusion was a mental illness, which it is not. In 2013, the “Diagnostic and Statistical Manual of Mental Disorders” of the American Psychiatric Association (APA), acknowledged that gender confusion becomes a medical condition only if actually affects one’s health or well-being and renamed it gender dysphoria.
It is important to understand that while gender dysphoria is a recognized medical condition, it is not a mental illness.
Examples of Gender Dysphoria
Children, adolescents, and adults may experience gender dysphoria. For example, young biologic girls may prefer to wear boys’ clothing, participate in boys’ activities, and express their desire to grow up and live as men. Similarly, young biological boys may say they wish they were girls or state that they will grow up to be women.
Gender dysphoric adults, feeling uncomfortable being treated by others according to the gender assigned to them by society, may adopt the behavior, clothing, and mannerisms of the gender with which they most closely identify.
The Language of Gender Identity
Understanding the true meaning and range of the gender dysphoria spectrum requires an understanding of some often-confused terms. For example, while they are often used interchangeably, “sex” and “gender” are not the same. According to current (2013) APA guidelines, the following definitions apply:
“Sex” refers to the biological differences between males and females based strictly on internal and external sex organs and chromosomes present at birth.
“Gender” refers to a person’s internal feelings of being male, female, a blend of both, or neither, according to generally accepted cultural or societal perceptions of masculinity or femininity. These personal feelings of masculinity or femininity make up one’s “gender identity.”
“Transgender” refers to persons whose sense of gender identity does not match their sex assigned at birth. For example, someone whose biological sex is male (has a penis) but who feels like a woman is a transgender. Transgender people often have a feeling that they were “born in the wrong body.”
“Transsexual” refers to gender dysphoric persons whose feelings of opposite-gender identity are so powerful that they take steps to assume the characteristics and gender-based roles of persons of the opposite sex. Transsexual persons may seek medical assistance—such as hormone replacement therapy or gender- reassignment surgery—to effectively change their physical appearance or gender.
“Gender Queer” refers to individuals whose gender identity and sometimes sexual orientation shift throughout their lifetimes.
“Gender Fluid” applies to persons who embrace different gender identities at different times.
“A-gendered” literally means “without gender,” and applies to people who identify as being of no gender at all.
“Cis-gender” describes persons whose gender identity or sexual expression aligns with the sex assigned to them at birth.
Gender Dysphoria and Sexuality
Many people incorrectly associate gender dysphoria with same sex attraction, assuming that all transgender persons are gay. This is a dangerous and potentially harmful misconception. People with gender dysphoria typically live as straight, gay, or bisexual, exactly like those whose gender identity aligns with their biological sex. Basically, gender dysphoria has no bearing on a person’s sexuality.
Brief History of Gender Dysphoria
Descriptions of gender dysphoria’s feelings of discomfort with one’s anatomical sex first appeared in medical literature during the middle of the 19th century.
Until the 1950s, gender nonconformity and same-sex relationships were almost universally considered to be socially objectionable forms of perversion. This negative perception began to change in late 1952 when Christine Jørgensen famously became the first American to undergo gender-reassignment surgery. After her secret surgery became known, she became one of the earliest advocates for the rights of transgender people.
In 1957, sexologist John William Money created and advocated for the concept of gender as a separate entity from sex. As a result of Money’s research, the feeling of confusion between anatomical sex and gender identity was classified as a form of mental illness called “gender identity disorder” by the American Psychiatric Association (APA) in 1980. This terminology contributed to the stigmatization and discrimination still experienced by transgender and gender-fluid individuals today.
Finally, in 2013, the APA recognized that “gender nonconformity is not in itself a mental disorder,” and reclassified “gender identity disorder” as “gender dysphoria,” which becomes a medical condition only if it results in actual mental or physical harm.
Despite this turning point in understanding on the part of the medical community, transgender people continue to face significant challenges in gaining equality and social acceptance.
Gender Dysphoria in Modern Society
Today as always, society places great importance on gender norms—the “socially-acceptable” ways of expressing gender and sexuality. Gender norms are passed from generation-to-generation by parents, teachers, friends, spiritual leaders, the media, and other social institutions.
Despite recent signs of better acceptance, such as legally-required transgender public bathrooms and gender-neutral college dorm rooms, many gender dysphoric persons continue to suffer as a result of their feelings.
According to the APA, physicians typically require that transsexual or transgender persons seeking hormone therapy or gender-reassignment surgery must first be examined and referred by a mental health provider.
Research conducted by the University of California in 2012, found that the rejection by the straight community experienced by transgender and transsexual people is actually significantly harsher than that experienced by lesbian, gay and bisexual (LGB) people. In addition, a study conducted by the Gay, Lesbian and Straight Education Network in 2009 found that transgender and transsexual students face much higher levels of on-campus harassment and violence than LGB students.
Perhaps most significantly, a 2011 study conducted by the Institute of Medicine concluded that the marginalization of gender dysphoric people by society is having a devastating effect on their physical and mental health. For example, the study found substantially higher rates of substance abuse, attempted suicide and HIV infection, and other medical problems in transgender and transsexual persons than those occurring in the general population.
Evidence of Change
Today, there are important signs that a more hopeful era of understanding and acceptance for gender dysphoric people is at hand.
The U.S. Equal Employment Opportunity Commission (EEOC) has banned all forms of discrimination against or harassment of individuals in the workplace because of their gender identity, including transgender status or sexual orientation. In addition, the U.S. Department of Defense now allows transgender, as well as gay and lesbian individuals to serve openly in all branches of the military.
More clinical studies are exploring treatment techniques for transgender people who seek it, as well as ways to prevent discrimination and harassment.
Finally, a growing number of universities are joining institutions like Brown, Cornell, Harvard, Princeton, and Yale in offering health insurance plans that include coverage for hormone therapy or gender-reassignment surgery for transgender students, faculty, and staff.