Gender in DSM-5

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Gender Dysphoria Disorder in DSM-5

Overview

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5 is a classification and diagnostic tool for psychiatric disorders. It describes Gender Dysphoria Disorder as the distress and discomfort experienced by an individual as a result of an incongruence between biological sex and experienced gender. [1] GDD emphasizes the distress experienced as a result of the incongruence between sex and gender, rather than the incongruence itself. Therefore, individuals who simply identify with another gender and experience no distress should not be diagnosed with gender dysphoria.

There is a shift in belief that gender is not dichotomous, and instead exists on a continuum or not at all.

Controversy

The medicalization of gender identity has been the subject of much controversy. On one hand, the inclusion of gender dysphoria as a psychiatric disorder has several proposed benefits. The outstanding argument is the legitimization of Gender Nonconformity or Gender Variance, which would then facilitate the sanction of medical, legal and financial aid for those experiencing distress. As a result, such support would improve the social and psychological well-being of gender nonconforming individuals through early intervention and supervised care. However, the medical view is based upon the assumption that GDD is a biological disease. Activists argue that labeling gender incongruence as a disorder simply reflects societal pressure for gender-role conformity and can actually increase distress due to an emphasis on GDD as an illness. GDD has been criticized as an attempt to pathologize gender identity and inherently suggests that an individual is disordered or deficient in some way because of their experience. Instead, GDD should concern the psychological and social components of the origin of distress, rather than biological. Furthermore, discrimination and stigma as a result of this label have major implications for the overall well-being and social integration of gender nonconforming individuals. [2] There is ongoing debate to remove gender identity disorders from the DSM-5 entirely.

Treatment and Mental Health

Medicalization

Current guidelines recommend the use of gonadotrophin-releasing hormone agonists (GnRHas) to suppress the onset of puberty as the treatment of choice for gender dysphoric adolescents. [3] However, the research on the efficacy and safety of this drug is extremely limited. In fact, few transgender youth that are eligible for treatment actually receive them, and the prescription of these pubertal blockers and sex hormones are uncommon. [4]

The use of drug therapy has been highly criticized (especially when administered to youth) for its negative side effects.

Depression, Suicide and Eating Disorders

Furthermore, trends in existing discourse emphasize that transgendered youth and children referred to physicians for gender identity concerns show increased rates of depression, suicidal tendencies, self-harm and eating disorders compared to cisgender youth and children not referred for gender identity concerns. [5] A common treatment for depression is through drug therapy, despite researchers raising concerns about the adverse side effects of antidepressants, especially for children and adolescents. Most concerning is that antidepressants may actually increase the rate of suicide ideation for some participants. [6] Other effective treatments include cognitive behavioural therapy, but unlike an increased advocacy for the use of medical blockers to target physical changes, there is a lack of support for the holistic community to implement alternative treatment facilities, perhaps due to inadequate funding.

Gender Typing in the Media

Dora The Explorer is popular female character that is both an ethnic minority and a brave leader.

Maladaptive parenting styles and media misrepresentations of gender largely interferes with a child’s ability to seek treatment for gender dysphoria, such that inadequate support and poor role models are correlated with increased reports of behavioural and emotional problems. [7] For instance, despite gender differences being very large and well documented in research, there has been little change in the prevalence of gender normative roles in media. Women are still under-represented, tend to be more sexualized and portray stereotypical roles such as housewives and subordinates. [8] Even recent discourse published in 2016 yield similar findings that on average, male characters tend to have more powerful roles. [9]These attitudes reflect gender schemas inherent in society that constitute gender typical roles and expectations. Given that most children watch television regularly, a large part of what they know and internalize about the world is a influenced by the media.

Correlation between Media Consumption and Belief about Gender Roles

Indeed, the relationship between media consumption and an individual's beliefs about gender normative roles are correlated; one study reported that a sample of adult male's media use is associated with more traditional beliefs about the male role. [10] After watching gender-stereotyped content, the audience was more likely to endorse gender stereotypes themselves. Mainstream media therefore, is a powerful medium for communicating cultural norms and values. The same effect is observed in a different study of young girls, such that frequent exposure to stereotypical female characters like Disney Princesses, led the audience to adopt narrower schemas in line with traditional female roles. [11] Continued exposure to gender-stereotyped media then reaffirms these normative constructs and further perpetuate the male and female binary as mutually exclusive, rather than promoting openness to a continuum for defining gender.

Dora the Explorer and Doc McStuffins

However, mainstream media can be utilized to encourage gender non-specific characters and reform how we view and present gender roles. Female characters like Dora from Dora the Explorer and Doc McStuffins, communicate bravery and heroism that is traditionally ascribed to males. Dora and Doc McStuffins challenge dominant race and gender ideologies by deviating from norms and taking on the roles as adventurous, brave female leaders. [12]

Gender Typing at Home

"Boys Will Be Boys"

Parents often convey subtle messages regarding gender through their remarks about male and female activities and characteristics. Phrases such as "boys will be boys" imply certain attributes are inherent to the group as whole. [13] These patterns in language convey the idea that gender is universal and stable, which may conflict with a child's sense of self and elicit distress. This explains the distress at the pinnacle of the DSM-5 diagnosis of GDD, but as a social by-product rather than a biological manifestation.

Bullying

A controversial article in 2014 followed the story of a 9 year-old boy Grayson Bruce who was bullied at school for bringing a My Little Pony backpack to school. The school administration told him to leave the backpack at home because it was "too girly" and a "trigger for bullying". His story led other individuals to share their experiences with discrimination and stigma. It is no wonder then, why there are concerns that the inclusion of GDD in the DSM-5 has severe social implications. Interestingly, My Little Pony actually has quite a large following among older male viewers. [14] More related articles about Bruce here and here.

References

  1. ↑ "Başar, K., Öz, G., & Karakaya, J. (2016). Perceived discrimination, social support, and quality of life in gender dysphoria. Journal Of Sexual Medicine, 13(7), 1133-1141. doi:10.1016/j.jsxm.2016.04.071"
  2. ↑ "de Vries, A. C., Steensma, T. D., Cohen-Kettenis, P. T., VanderLaan, D. P., & Zucker, K. J. (2016). Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child & Adolescent Psychiatry, 25(6), 579-588. doi:10.1007/s00787-015-0764-7"
  3. ↑ "Schagen, S. E., Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Hannema, S. E. (2016). Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. Journal Of Sexual Medicine, 13(7), 1125-1132. doi:10.1016/j.jsxm.2016.05.004"
  4. ↑ "Gridley, S. J., Crouch, J. M., Evans, Y., Eng, W., Antoon, E., Lyapustina, M., & ... Breland, D. J. (2016). Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. Journal Of Adolescent Health, 59(3), 254-261. doi:10.1016/j.jadohealth.2016.03.017"
  5. ↑ "Connolly, M. D., Zervos, M. J., Barone, C. I., Johnson, C. C., & Joseph, C. M. (2016). The mental health of transgender youth: Advances in understanding. Journal Of Adolescent Health, 59(5), 489-495. doi:10.1016/j.jadohealth.2016.06.012"
  6. ↑ "Aitken, M., VanderLaan, D. P., Wasserman, L., Stojanovski, S., & Zucker, K. J. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal Of The American Academy Of Child & Adolescent Psychiatry, 55(6), 513-520. doi:10.1016/j.jaac.2016.04.001"
  7. ↑ "Cohen-Kettenis, P. T., & Van Goozen, S. M. (2002). Adolescents who are eligible for sex reassignment surgery: Parental reports of emotional and behavioural problems. Clinical Child Psychology And Psychiatry, 7(3), 412-422. doi:10.1177/1359104502007003008"
  8. ↑ "Giaccardi, S., Ward, L. M., Seabrook, R. C., Manago, A., & Lippman, J. (2016). Media and modern manhood: Testing associations between media consumption and young men’s acceptance of traditional gender ideologies. Sex Roles, 75(3-4), 151-163. doi:10.1007/s11199-016-0588-z"
  9. ↑ "Kennard, A. R., Willis, L. E., Robinson, M. J., & Knobloch‐Westerwick, S. (2016). The allure of Aphrodite: How gender-congruent media portrayals impact adult women's possible future selves. Human Communication Research, 42(2), 221-245. doi:10.1111/hcre.12072"
  10. ↑ "Giaccardi, S., Ward, L. M., Seabrook, R. C., Manago, A., & Lippman, J. (2016). Media and modern manhood: Testing associations between media consumption and young men’s acceptance of traditional gender ideologies. Sex Roles, 75(3-4), 151-163. doi:10.1007/s11199-016-0588-z"
  11. ↑ "Coyne, S. M., Linder, J. R., Rasmussen, E. E., Nelson, D. A., & Birkbeck, V. (2016). Pretty as a princess: Longitudinal effects of engagement with Disney Princesses on gender stereotypes, body esteem, and prosocial behavior in children. Child Development, 87(6), 1909-1925. doi:10.1111/cdev.12569"
  12. ↑ "Keys, J. (2016). Doc McStuffins and Dora the Explorer: Representations of gender, race, and class in US animation. Journal Of Children And Media, 10(3), 355-368. doi:10.1080/17482798.2015.1127835"
  13. ↑ "Valiente, C., & Rasmusson, X. (2015). Bucking the stereotypes: My Little Pony and challenges to traditional gender roles. Journal Of Psychological Issues In Organizational Culture, 5(4), 88-97. doi:10.1002/jpoc.21162"
  14. ↑ "Valiente, C., & Rasmusson, X. (2015). Bucking the stereotypes: My Little Pony and challenges to traditional gender roles. Journal Of Psychological Issues In Organizational Culture, 5(4), 88-97. doi:10.1002/jpoc.21162"

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