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Gender dysphoria (sometimes, but not preferably, gender identity disorder) is felt by individuals who experience significant discontent from their gender assigned at birth. It is also a formal psychological and psychiatric diagnosis. Not all authorities classify this as a mental illness; the National Health Service in the United Kingdom describes it as "a condition for which medical treatment is appropriate in some cases."
Recent research has indicated that transgender people tend to have the same or similar brain structures as their identified gender, even before hormone replacement, thus giving the terms "gender" and "sex" a more complex relationship than before, seeing as it has been proven the former is not just a social construct. Possible causes of gender dysphoria include genetics, upbringing, and prenatal exposure to particular hormones, among others.
As a minor concession to the trans community, in response to complaints that "gender identity disorder" was a stigmatizing term, the American Psychiatric Association changed the "Gender Identity Disorder" diagnostic category in the DSM-5 to "Gender Dysphoria" in 2013. The APA, as well as the larger Western healthcare structures, remains highly conservative on the issue, to the point that there are thriving black and grey markets for prescription hormones and some cosmetic treatments. Some clinics have sought to move past this issue by offering "informed consent" prescriptions, for which a psychiatric diagnosis is not required.
Gender dysphoria described by trans people
As a shoe metaphor
If you're wearing comfortable shoes, you don't spend all your time thinking about how your feet don't hurt. But if you're wearing uncomfortable shoes... ow, ow, ow.
As body horror
Someone assigned female at birth with body-related gender dysphoria once described the experience of having breasts as having two alien jellyfish constantly suctioned onto one's chest. Similarly, some individuals assigned male at birth who feel dysphoric about their genitals describe the feeling as having a big raw chicken stapled between one's legs. Try imagining how that must feel.
Confusion with body dysmorphia
Many people and even some LGBT organizations make the mistake of mixing up gender dysphoria with body dysmorphia. This can lead to people suffering from gender dysphoria being told they're just delusional (or conversely, sometimes a body dysmorphia sufferer gets asked some awkward questions). Despite the superficial similarity, they are two vastly different things; body dysmorphic disorder (BDD) is a mental illness on the OCD spectrum where the sufferer is extremely anxious about their appearance and spends a great deal of time fixating on and obsessing over perceived bodily flaws which are either grossly exaggerated in their mind or may not even exist at all, whereas gender dysphoria is a mismatch between gender and biological sex.
People with body dysmorphia sometimes seek out surgery to correct what they perceive as their physical flaws, even going to the extent of having repeated surgeries on the same body part. However, since this does not address the underlying mental issue, this does not alleviate the dysmorphia, which simply returns and continues to cause distress. By contrast, transgender people who decide to transition often find that their dysphoria is alleviated by some combination of sex reassignment surgery, hormone replacement therapy, and social transition (wearing gender-appropriate clothing, changing name and pronouns, etc.). Trans people with gender dysphoria do not have a skewed body image like people with body dysmorphia (and some other psychiatric conditions, eg. eating disorders) do; they simply feel like their bodies are wrong for their gender identity and would feel much more comfortable in a body of the opposite sex. As an analogy: someone who, from birth, has been having a notable amount more difficulty reading things at a distance than their friends might want to try wearing glasses or getting laser eye surgery, and is not mentally ill or delusional; on the other hand, someone who has gotten the deep-seated impression that everyone else's peripheral vision is exactly as well-focused as their center of vision and tries to "fix" themselves with excessive, almost dangerous amounts of eye-drop definitely is mentally ill.
- Gender Identity Disorder Today DSM IV Gender Identity Disorder
- "Transgender experiences – Information and support"
- Transsexual differences caught on brain scan
- Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus
- DSM-V revision fact sheet