Transvestic disorder. Transvestic disorder occurs in heterosexual (or bisexual) adoles- gender into question. It is occasionally accompanied by gender dysphoria. An individual both diagnoses. In many cases of late-onset gender dysphoria in gynephilic natal males, transvestic behavior with sexual excitement is a precursor.
Body dysmorphic disorder. An individual with body dysmorphic disorder focuses on the alteration or removal of a specific body part because it is perceived as abnormally formed, not because it represents a repudiated assigned gender. When an individual’s presenta— tion meets criteria for both gender dysphoria and body dysmorphic disorder, both diag- noses can be given. Individuals wishing to have a healthy limb amputated (termed by some body integrity identity disorder) because it makes them feel more ”complete” usually do not wish to change gender, but rather desire to live as an amputee or a disabled person.
Schizophrenia and other psychotic disorders. In schizophrenia, there may rarely be delusions of belonging to some other gender. In the absence of psychotic symptoms, in- sistence by an individual with gender dysphoria that he or she is of some other gender is not considered a delusion. Schizophrenia (or other psychotic disorders) and gender dys- phoria may co—occur.
Other clinical presentations. Some individuals with an emasculinization desire who develop an alternative, nonmale/nonfemale gender identity do have a presentation that meets criteria for gender dysphoria. However, some males seek castration and / or penec- tomy for aesthetic reasons or to remove psychological effects of androgens without chang- ing male identity; in these cases, the criteria for gender dysphoria are not met.
Clinically referred children with gender dysphoria show elevated levels of emotional and behavioral problems—most commonly, anxiety, disruptive and impulse—control, and de- pressive disorders. In prepubertal children, increasing age is associated with having more behavioral or emotional problems; this is related to the increasing non—acceptance of gen- der-variant behavior by others. In older children, gender-variant behavior often leads to peer ostracism, which may lead to more behavioral problems. The prevalence of mental health problems differs among cultures; these differences may also be related to differences in attitudes toward gender variance in children. However, also in some non—Western cul- tures, anxiety has been found to be relatively common in individuals with gender dysphoria, even in cultures with accepting attitudes toward gender-variant behavior. Autism spec- trum disorder is more prevalent in clinically referred children with gender dysphoria than in the general population. Clinically referred adolescents with gender dysphoria appear to have comorbid mental disorders, with anxiety and depressive disorders being the most common. As in children, autism spectrum disorder is more prevalent in clinically referred adolescents with gender dysphoria than in the general population. Clinically referred adults with gender dysphoria may have coexisting mental health problems, most commonly anxiety and depressive disorders.
302.6 (F64.8)
This category applies to presentations in which symptoms characteristic of gender dys- phoria that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for gender dys- phoria. The other specified gender dysphoria category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for gender dysphoria. This is done by recording “other specified gender dys- phoria" followed by the specific reason (e.g., “brief gender dysphoria").
An example of a presentation that can be specified using the "other specified" desig- nation is the following:
The current disturbance meets symptom criteria for gender dysphoria, but the duration is less than 6 months.
302.6 (F64.9)