From Disorder to Dysphoria: Transgender Identity and the DSM-V


This spring marks the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder, or the DSM-V. After fifteen years of revision, the American Psychiatric Association’s board of trustees approved to changes including the removal of the term Gender Identity Disorder. 

Simultaneously, the term Gender Dysphoria will be used to diagnose the distress occurring over a “marked incongruence between one’s experienced gender and assigned gender,” Dani Haffernan reported for  

Although linguistically subtle, the difference between ‘disorder’ and dysphoria’ should have a huge impact on the outlook and treatment of transgendered individuals.

According to the National Institute of Mental Health (NIMH), disorders are thought of as “a clinically significant behavior, psychologically syndrome, or a pattern that occurs in an individual typically associated with distress, painful symptomology, disability or impairment.” 

Dysphoria, on the other hand, is a “psychological state that causes one to experience feelings of anxiety, restlessness and depression. It is not necessarily diagnosable, or something that would be identified in the DSM, but it is more a state of being, a feeling or unpleasantness or discomfort.”       

The previous diagnosis of GID implied that the problem lie within the client, further suggesting that the client needed to be cured or somehow mentally and emotionally fixed. The pending reclassification speaks to the mental state that accompanies being transgendered within this society. 

Rather than indicating that a person needs to be fixed, the diagnosis indicates that the issues that need to be addressed lie outside the individual. Kelly Winters, from the group GID Reform Advocates, believes that the change in diagnosis signifies that “the problem to be treated is not the person’s identity, but rather the distress that is often experienced by those who need access to medical transition care.”     
Although transgender individuals are still dependent upon these institutions, the removal of GID is compared to the organization’s declassification of homosexuality as a mental disorder in 1973. 

Prior to its removal, homosexuality was cause for therapy and institutionalization. 

Although the social climate and treatment of mental health patients have changed since gays and lesbians could be institutionalized for their diagnosis, transgendered individuals who were diagnosed with GID were still left potentially vulnerable to medical and mental health workers.  

Winters further states that the change in the diagnosis signals a change of attitude within the APA that our gender identities are no longer considered the focus of pathology. 

“But the fact remains that trans and especially transsexual folks needing hormonal or surgical transition care are still classified as mentally disordered.” 

Although this keeps the relationship between the transgendered community and health institutions strong, due to the need for hormones and surgeries, it does show a cultural shift in acceptance and understanding. 

Prior to the change, the term ‘disorder’ gave the impression, both socially and psychologically, that there was something damaged or dangerous  about transgendered individuals, much like a mood disorder would someone feel he or she was unstable or unable to function in society. 

Removing the stigma is the first step in social change, taking the transgender community out of the mental health field toward an accepting society.      


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