What Is Gender Dysphoria? A Critical Systematic Narrative Review

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association has changed the diagnosis of gender identity disorder to gender dysphoria (GD). In this critical narrative review we ask: What is gender dysphoria? We report on some of the inconsistencies in the articles that foreground distress while obfuscating the fact that not all trans and intersex people suffer stress or impaired functioning, and the inappropriate referencing to intersex people in the diagnostic criterion, claims about the GD diagnosis contributing to the depathologization of and reducing stigma surrounding trans people, the conceptualizations of “gender dysphoric” research subjects, and finally we question the etiological approaches using GD as a conceptual framework. We further suggest that there are a number of methodological issues that need to be resolved to be able to claim that the GD diagnosis can be validated. To shed light on these paradoxes and methodological issues in the DSM-5, we report on the content validity of GD by reviewing research articles postdiagnostic inception. These findings will contribute to the debate about the validity of GD as a diagnosis for the 21st century for those people who need to live a different gender to that assigned at birth

A values-driven and evidence-based health care psychology for diverse sex development

The integration of psychology into multidisciplinary care for people affected by 'disorders of sex development' is acknowledged in most recent care standard documents. However, psychological evidence that can inform service development is currently insubstantial for specific reasons, some of which are outlined in this article. We argue for psychological activities and their prioritisation to be equally driven by the professional values embedded in clinical psychology and to seek user input in key activities. These values include critical engagement with research literature, theoretically informed question and problem formulation, development of interventions to boost health and well-being, honouring of personal agency, equality and diversity, team development facilitation, psychological education and training for non-psychologists, audit and research that can benefit patients and contribution to social change. We outline target areas that reflect these values and, where possible, draw on empirical evidence developed in diverse sex development (DSD) and other clinical contexts to support our recommendations