Editing Gender dysphoria (section)

== Society and culture ==
[[File:2013 Rally for Transgender Equality 21175.jpg|right|thumb|A sign at a trans rights rally: "Gender is like that old jumper from my cousin: It was given to me and it doesn't fit."]]
Researchers disagree about the nature of distress and impairment in people with GD. Some authors have suggested that people with GD suffer because they are [[social stigma|stigmatized]] and [[victimisation|victimized]];<ref name="Karl Bryant"/><ref name=":2">{{Cite book |vauthors=Bryant KE |title=The Politics of Pathology and the Making of Gender Identity Disorder |year=2007 |isbn=978-0-549-26816-1 |location=Ann Arbor, Michigan |page=222}}</ref> and that, if society had less strict gender divisions, transgender people would suffer less.<ref name="Giordano-2012">{{Cite book |vauthors=Giordano S |title=Children with Gender Identity Disorder: A Clinical, Ethical, and Legal Analysis |publisher=[[Routledge]] |year=2012 |isbn=978-0-415-50271-9 |location=New Jersey |page=147}}</ref>

Some controversy surrounds the creation of the GD diagnosis, with Davy et al. stating that although the creators of the diagnosis state that it has rigorous scientific support, "it is impossible to scrutinize such claims, since the discussions, methodological processes, and promised field trials of the diagnosis have not been published."<ref name="Davy"/>

Some cultures have [[Third gender|three or more defined genders]]. The existence of accepted social categories other than man or woman may alleviate the distress associated with cross-gender identity. For example, in [[Samoa]], the ''[[fa'afafine]]'', a group of [[feminine males]], are mostly socially accepted. The fa'afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior, but experience far less distress than do transgender women in Western cultures. This suggests that the distress of gender dysphoria is significantly increased by difficulties encountered from social disapproval by one's culture.<ref name="fa'afafine">{{cite journal |vauthors=Vasey PL, Bartlett NH |title=What can the Samoan "Fa'afafine" teach us about the Western concept of gender identity disorder in childhood? |journal=[[Perspectives in Biology and Medicine]] |volume=50 |issue=4 |pages=481–490 |year=2007 |pmid=17951883 |doi=10.1353/pbm.2007.0056 |s2cid=37437172}}</ref> Overall, it is unclear whether or not gender dysphoria persists in cultures with third gender categories.<ref>{{cite book |url=https://archive.org/details/diagnosticstatis0005unse/page/459 |title=Diagnostic and Statistical Manual of Mental Disorders 5 |publisher=[[American Psychiatric Association]] |year=2013 |isbn=978-0-89042-555-8 |page=[https://archive.org/details/diagnosticstatis0005unse/page/457 457]}}</ref>

=== Classification as a disorder ===
The [[mental disorder|psychiatric diagnosis]] of gender identity disorder (now gender dysphoria) was introduced in DSM-III in 1980. [[Arlene Istar Lev]] and [[Deborah Rudacille]] have characterized the addition as a political maneuver to re-stigmatize homosexuality.<ref>{{cite book |vauthors=Lev AI |url=https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172 |title=Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families |publisher=Haworth Press |year=2004 |isbn=978-0-7890-2117-5 |page=172 |author-link=Arlene Istar Lev |access-date=November 11, 2020 |archive-date=January 23, 2021 |archive-url=https://web.archive.org/web/20210123073430/https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172|url-status=live}}</ref><ref>{{cite book |vauthors=Rudacille D |title=The Riddle of Gender: Science, Activism, and Transgender Rights |date=February 2005 |publisher=Pantheon |isbn=978-0-375-42162-4 |author-link=Deborah Rudacille}}{{page needed|date=May 2016}}</ref> (Homosexuality was [[Homosexuality in the DSM|declassified as a mental disorder]] in the DSM-II in 1974.) By contrast, [[Kenneth Zucker]] and [[Robert Spitzer (psychiatrist)|Robert Spitzer]] argue that gender identity disorder was included in DSM-III because it "met the generally accepted criteria used by the framers of DSM-III for inclusion."<ref name="Historical Note">{{cite journal | vauthors = Zucker KJ, Spitzer RL | title = Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note | journal = Journal of Sex & Marital Therapy | volume = 31 | issue = 1 | pages = 31–42 | date = Jan–Feb 2005 | pmid = 15841704 | doi = 10.1080/00926230590475251 | author2-link = Robert Spitzer (psychiatrist) | s2cid = 22589255 | author-link = Kenneth Zucker }}</ref> Some researchers, including Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.<ref name="PsychNews">{{cite news | vauthors = Hausman K | date = 18 July 2003 |title=Controversy Continues to Grow Over DSM's GID Diagnosis|publisher=Psychiatric News|url=http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462|access-date=2014-05-22|archive-date=2014-05-22|archive-url=https://web.archive.org/web/20140522142507/http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462|url-status=live}}</ref> The American Psychiatric Association stated that [[gender nonconformity]] is not the same thing as gender dysphoria,<ref name="What Is"/> and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."<ref name="DSM-5 fact sheet"/>

Individuals with gender dysphoria may or may not regard their own cross-gender feelings and behaviors as a disorder. Advantages and disadvantages exist to classifying gender dysphoria as a disorder.<ref name="Standards of Care" /> Because gender dysphoria had been classified as a disorder in medical texts (such as the previous DSM manual, the DSM-IV-TR, under the name "gender identity disorder"), many insurance companies are willing to cover some of the expenses of sex reassignment therapy. Without the classification of gender dysphoria as a medical disorder, sex reassignment therapy may be viewed as a cosmetic treatment, rather than medically necessary treatment, and may not be covered.<ref name="Zack Ford">{{cite web| vauthors = Ford Z |title=APA Revises Manual: Being Transgender is No Longer a Mental Disorder|website=[[ThinkProgress]]|url=http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc|url-status=dead|archive-url=https://web.archive.org/web/20130202082602/http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc|archive-date=February 2, 2013|access-date=April 7, 2013}}</ref> In the United States, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.<ref>{{Cite book| vauthors = Mallon GP |title=Social Work Practice with Transgender and Gender Variant Youth|publisher=Routledge|year=2009|isbn=978-0-415-99482-8|location=New Jersey}}</ref> The [[Americans with Disabilities Act]] covers individuals with gender dysphoria,<ref>{{cite news |author=Devan Cole |title=Federal appeals court says Americans with Disabilities Act protections cover 'gender dysphoria,' handing a win to trans people |url= https://www.cnn.com/2022/08/16/politics/americans-with-disabilities-act-transgender-gender-dysphoria/index.html |access-date=5 September 2022 |work=CNN |agency=CNN}}</ref> provides some legal protections against discrimination which may aid transgender people in accessing legal protections they otherwise may be unable to.{{Original research inline|date=October 2024}} Some researchers and transgender people support declassification of the condition because they say the diagnosis [[pathologizes]] gender variance and reinforces the [[Gender binary|binary model of gender]].<ref name="Karl Bryant" />

An analysis of the Samoan third gender ''fa'afafine'' suggests that the DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.<ref name="fa'afafine" /> Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child's gender variance.<ref name="PsychNews" /> Transgender people have often been harassed, socially excluded, and subjected to discrimination, abuse and violence, including murder.<ref name="Davidson-2012" /><ref name="Giordano-2012" />

In December 2002, the British Lord Chancellor's office published a ''Government Policy Concerning Transsexual People'' document that categorically states, "What transsexualism is not ... It is not a mental illness."<ref>{{cite web|year=2003|title=Government Policy concerning Transsexual People|url=http://www.dca.gov.uk/constitution/transsex/policy.htm|url-status=dead|archive-url=https://web.archive.org/web/20080511211217/http://www.dca.gov.uk/constitution/transsex/policy.htm|archive-date=May 11, 2008|work=People's rights/Transsexual people|publisher=U.K. Department for Constitutional Affairs}}</ref> In May 2009, the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition,<ref>{{cite news|date=May 16, 2009|title=La transsexualité ne sera plus classée comme affectation psychiatrique|work=Le Monde|url=http://www.lemonde.fr/societe/article/2009/05/16/la-transsexualite-ne-sera-plus-classee-comme-affectation-psychiatrique_1193860_3224.html|access-date=May 31, 2009|archive-date=February 26, 2018|archive-url=https://web.archive.org/web/20180226213224/http://www.lemonde.fr/societe/article/2009/05/16/la-transsexualite-ne-sera-plus-classee-comme-affectation-psychiatrique_1193860_3224.html|url-status=live}}</ref> but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.<ref>{{Cite news |date=May 17, 2011 |title=La France est très en retard dans la prise en charge des transsexuels |trans-title=France is far behind in caring for transsexuals |language=fr |work=Libération |url=http://www.liberation.fr/societe/2011/05/17/la-france-est-tres-en-retard-dans-la-prise-en-charge-des-transsexuels_736344 |quote=En réalité, ce décret n'a été rien d'autre qu'un coup médiatique, un très bel effet d'annonce. Sur le terrain, rien n'a changé. |trans-quote=In reality, this decree was nothing other than a media stunt, a very good publicity effect. On the ground, nothing has changed. |access-date=March 11, 2018 |archive-date=November 30, 2014 |archive-url=https://web.archive.org/web/20141130231929/http://www.liberation.fr/societe/2011/05/17/la-france-est-tres-en-retard-dans-la-prise-en-charge-des-transsexuels_736344 |url-status=live}}</ref> Denmark made a similar statement in 2016.<ref>{{Cite news |vauthors=Worley W |date=May 14, 2016 |title=Denmark will become first country to no longer define being transgender as a mental illness |work=[[The Independent]] |url=https://www.independent.co.uk/news/world/europe/denmark-will-be-the-first-country-to-no-longer-define-being-transgender-as-a-mental-illness-a7029151.html |access-date=March 22, 2018 |archive-date=March 11, 2018 |archive-url=https://web.archive.org/web/20180311201855/http://www.independent.co.uk/news/world/europe/denmark-will-be-the-first-country-to-no-longer-define-being-transgender-as-a-mental-illness-a7029151.html |url-status=live}}</ref>

In the ICD-11, GID is reclassified as "gender incongruence", a condition related to sexual health.<ref name="icd11-gc" /> The working group responsible for this recategorization recommended keeping such a diagnosis in ICD-11 to preserve access to health services.<ref name="pmid27717275">{{cite journal |vauthors=Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen-Kettenis PT, Arango-de Montis I, Parish SJ, Cottler S, Briken P, Saxena S |display-authors=6 |title=Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations |journal=[[World Psychiatry]] |volume=15 |issue=3 |pages=205–221 |date=October 2016 |pmid=27717275 |pmc=5032510 |doi=10.1002/wps.20354}}</ref>