Gender dysphoria: types, causes, symptoms and treatment. Violation of gender identity in children and adults. Family problems related to gender violations

Most people are faced with psychological problems, but few people have an understanding of gender dysphoria.

So what is it? Illness or mild depression? Who is affected and in what cases? What are its causes and treatments?

Introduction

A person is born into the world with physiological features independent of his choice. They are fixed at the genetic level, which can be changed to this stage development of science is not possible.

Yes, most main feature is the biological sex registered at birth.

biological sex

From the point of view of biology, a person belongs to the order of primates of the genus hominids (great apes, humans and their extinct ancestors), as a result of which he is a representative of one of three types of sex:

1. Female - consists of two X chromosomes.
2. Male - consists of two different chromosomes such as X and Y.
3. Intersex, i.e. deviant from the norm of chromosomes and including the signs of both sexes indicated above. They are also called hermaphrodites.

Everyone knows what distinguishes a person as a biological being from his younger relatives:

• the presence of consciousness, thinking and speech;
• labor (production of tools);
• the need for spiritual and moral development.

However, homo sapiens is not only a biological, but also a social entity capable of going against the iron laws of nature.

social gender

Despite the biological principle, a person exists within the framework of society, in which he develops according to a certain model of behavior and is perceived by society, respectively - as a man or a woman. Such a system is called a social role. It is formed in the process of personality education and includes psychological differences between the two characteristics.

A person who occupies a certain social status is somehow seen as a representative of a particular gender. However, it is no longer biological, but social. In modern terminology for similar situation use the concept of gender.

gender education

As mentioned earlier, a person develops according to a certain model of behavior and this model determines his biological sex. But there are exceptions in which gender does not correspond to the gender assigned from birth. This phenomenon is called transgender.

More specifically:

• transgender - mismatch of gender identity with biological gender;
• gender identity - self-perception of oneself as a representative of one sex or another;
• people who face the problem of gender identity are called transgenders.

Transgender is still considered a diagnosis and is included in the International Classification of Diseases 10th edition (ICD-10). The diagnosis can be found in block F64.0 - "Disorders of gender identity. Transsexualism." This term was introduced by the German doctor M. Hirschfeld back in 1923.

Dysphoria: its general definition

Dysphoria (Greek dysphoreo - irritation) - painfully negative emotional condition, in which a person is in a low and irritable mood. Dysphoria is observed in a number of diseases.

List of the most common ones:

• schizophrenia;
• epilepsy;
• withdrawal syndrome;
• anxiety disorder;
• rheumatism;
• post-traumatic disorder;
• hypoglycemia;
• traumatic and vascular lesions brain;
• abnormal hormonal background;
• premenstrual state;
• personality disorders;
• transgender.

As well as situations in the experience of which there is a possibility of stress.

Types of dysphoria

Dysphoria is divided into:

• postcoital - a state of depression after intercourse;
• premenstrual - a common occurrence among women;
• gender - the most complex and serious type of all of the above.

Types of gender dysphoria are distinguished by severity. She may be:

• mild (problems mostly only with society);
• middle (incomplete self-acceptance and rejection from the outside);
• severe (lack of inner harmony and hatred on the part of people).

AT International Classification Diseases of the 11th revision, block F64 "Gender identity disorders" was replaced by "Gender dysphoria", thus merging with the previous version of the 10th edition into one general concept.

Experts also propose to withdraw this term from mental disorders to the department of sexology, which means the complete deregistration of transsexualism as a diagnosis. In 2018, the 11th revision of the ICD should come into force.

root causes

According to scientists in the course of research, transgenderism should not be perceived as a purely sociocultural phenomenon.

Because:

• According to the study of the relationship between transsexualism and the structure of the brain, it turned out that gender dysphoria is the result of an altered interaction between the brain and sex hormones.
• Recent magnetic resonance imaging diagnostics showed that the insular (responsible for body perception) lobe of the brain in transsexuals was larger than in men, but smaller than in women. As a result, scientists conclude: the physiological differences in the brain are laid back in the period prenatal development.
• Naturally occurring hermaphroditism is a gene mutation.

Research and theories on this issue are still ongoing and are very controversial among specialists.

Symptoms

The main symptoms of gender dysphoria are clear:

• Unconscious perception of oneself as a person of the opposite sex from early childhood. But it’s worth noting right away that not all transgender people experience this with early years own life. Often, awareness comes in adolescence, when the body begins to develop according to one or another sexual physiology.

• Unwillingness to live in the gender role assigned to him from birth and expected by society in later life. In childhood, the situation manifests itself in the refusal to wear feminine (if it is a girl) and masculine (if it is a boy) things. The child has an involuntary desire to play toys uncharacteristic of his biological sex in the company of the same children, to whom he unconsciously refers himself.

• During puberty, the hostility to their genitals and changes in the body is especially aggravated. It is during this period that gender dysphoria most often strikes a nuclear blow. Teenagers can't control physiological development and change the process to opposite side. A young transgender person is not perceived by society as he identifies himself, and cannot find a place for himself in society with traditional values. Trans people are subjected to both psychological and physical pressure from the outside, which clearly affects their internal state.

Chief among all the signs of gender dysphoria is the belief that oneself belongs to a person of the opposite sex and does not correspond to this in real life.

All of the above items in most cases worsen over time and eventually reach lethal outcome. Transsexuals become unable to resist both the internal struggle with themselves and the external struggle with a merciless society, therefore they decide on the most desperate way out of the situation - suicide.

In order to avoid a fatal outcome, the causes of gender dysphoria must be eliminated by providing mandatory assistance - gender reassignment.

Therapy

Studies by American scientists confirm that transgenderness in itself is not a diagnosis and is not interconnected with sexual orientation. However, treatment is necessary and the cause removed dire consequences Maybe in the following ways:

• psychotherapy;
• hormone therapy;
• surgical intervention.

It is worth noting that not all transgender people decide to go through a full course of therapy. Each situation is considered purely individual, and satisfaction with one's condition can come on different stages gender correction.

To receive help and a certificate with a diagnosis of "F64.0 Transsexualism", the patient must undergo a psychiatric commission. It is carried out for the purpose of an accurate diagnosis (according to the still valid ICD-10). Doctors assess emotional state to rule out mental disorders that can provoke false transsexualism. Such an example may be a dissociative disorder, in other words, a split personality.

After receiving a certificate, a transgender person has several options for further action:

1. Lifetime admission hormone replacement therapy(HRT).

For women who want to bring their social gender into harmony with the biological one, courses of male hormones are prescribed. Most often, testosterone is injected into the body intramuscularly. For such cases in medicine there is a definition - FtM (Female to Male), which means "from a woman to a man."

For men planning to reunite the spiritual women Health with bodily, prescribe the hormone estrogen. In medical circles, patients are called MtF (Male to Female) - "from male to female."

2. Surgical intervention in order to adjust the sexual characteristics according to the desired type.

FtM remove the mammary glands and shape the breast according to male type, remove the ovaries, appendages and uterus. At the end, phalloplasty is performed - the creation of the male genital organ.

MtF exercise cosmetic procedures to soften facial features (optional), as well as enlarge the breasts and shape the female genital organs (vaginoplasty).

In addition to the medical problem, the problem is also solved from the legal side: all documents are drawn up anew with a change in the "gender" column and a new name.

Benjamin Gender Identity Scale

The gender dysphoria test is associated with the name American doctor Harry Benjamin. He was the first to attempt to classify forms of gender-variant behavior. His attempt was to create a scale of 6 categories:

1. Pseudo-transvestism.
2. Fetish transvestism.
3. True transvestism.
4. Non-op transsexualism.
5. Nuclear transsexualism with medium degree gender dysphoria.
6. Nuclear transsexualism with a severe degree of disorder.

However, the current views do not correspond to the vision of a specialist. Sexual orientation is not seen as a criterion for distinguishing between transsexuality and transvestism.

Until now, there is confusion in these concepts, which should be dispelled.

Transvestism is a psychological phenomenon in which there is a desire to transform into a person of the opposite sex by changing clothes and acquiring accessories characteristic of this sex.

Transvestism does not always equal transsexualism. It is men who are most often representatives of this phenomenon, and they do not have a desire to correct their biological sex. When a person does not experience discomfort with his body and satisfies sexual needs with the help of dressing up, we are not talking about gender dysphoria.

Most effective way testing - making an appointment with a psychotherapist who will help you sort out your identity in case of any doubts.

Outcome

Treating gender dysphoria entails irreversible consequences in the body, therefore sex correction is possible only after passing a psychiatric commission and in the subsequent strict supervision of doctors. However, therapy for transsexuality is necessary. It can improve psychological and physical condition person.

Transgender people have the opportunity to live full life and perceived by society in the desired gender.

People suffering from gender dysphoria are full-fledged mentally and intellectually. But with the development certain diseases psyche (for example, schizophrenia), the patient often raves about changing sex. He claims that he is being affected by waves or radiation, which has already changed his gender. Since such complaints are common, the requirements for mental health a person who wants to change sex are very strict: passing a medical and psychological-psychiatric examination.

Reasons for the development of the disease

Gender dysphoria (gender identity disorder) is a mental illness that is a violation in the awareness of one's gender. In other words, a person who has this disease, feels in the opposite body. In society, such people are usually called transsexuals.

Since gender dysphoria was recognized as a disease only recently, the causes of this disorder are not fully understood. There are several hypotheses:

• The biological basis of gender dysphoria. Miscellaneous diseases pregnant woman and disorders in hormonal background can lead to an incorrect formation of the psychological perception of sex in a child. Too much testosterone in future mother renders Negative influence on the female fetus: lead to muscularity as they grow older, and vice versa - increased estrogen production can affect the male fetus. But not in all cases these changes occur. The use of hormonal therapy is very common, so much more would have to be observed. more people-transgenders, if its use would necessarily lead to violations in gender identification.
• Mismatch of chromosomal and external sex. This happens if the girl has adrenogenital syndrome, and the boy has androgen insensitivity syndrome. With a pronounced form of these diseases, errors occur in sex determination in young age, and the upbringing of the baby takes place in accordance with the stereotype of the opposite sex. Only genetic expertise will help determine the gender of this person. Such situations cannot be classified as "pure" dysphoria, but they have similar symptoms. Some diseases endocrine system manifest themselves as a mismatch in the perception of sex from the point of view of psychology and biology.
• Hidden hermaphroditism. In the history of medicine, there are cases when, during the examination of a man for the preparation of a sex change operation, partially developed genitals of a woman were found in him.

AT this moment main reason gender dysphoria remains the theory of intrauterine developmental disorders of the fetus.

Symptoms of the disease

Gender dysphoria usually begins to manifest itself with early age. These children have a feeling of being in the wrong body.

The child may have the following symptoms:

• rejection of one's own clothes, desire to wear clothes of the opposite sex;
• refusal to play characteristic roles, giving preference to the opposite;
• lack of desire to perform the process of urination in a manner characteristic of his gender: the boy tries to do it like a girl, and vice versa;
• an acute desire, a dream of liberation from his own genitals (the boy wants to get rid of the penis when he becomes an adult);
• the onset of puberty turns into a tragedy;
• stubborn proof of the opposite sex;
• disgust for one's own genitals, conscious concealment of gender indicators (girls different ways hide the chest, the young men - the vegetation on the body).

Such manifestations of violations in the sexual sphere significantly complicate the adaptation of the patient in society. The experience and suffering of the child adolescence lead to the emergence deep depressions sometimes suicidal thoughts.

Disease classification

The Benjamin scale shows that the disorder is manifesting different forms with certain features. This classification is designed to describe the disease in a biological male, but it is easy to change to characterize the symptoms in women.

Dysphoria: symptoms and treatment. gender dysphoria

Many people are familiar with mood swings and despondency. Usually this is nothing to worry about, but sometimes prolonged blues is a symptom of mental illness. It is important to distinguish the reduced emotional background from dysphoria in time. What it is? How to deal with it? When is it time to see a doctor?

This word is the antonym of the word "euphoria", from the Greek language it is translated as "to suffer, to suffer."

Dysphoria is a depressed mood, combined with gloomy irritability, melancholy, hostility towards others, aggressiveness. It is violence directed at another person or oneself that is the main diagnostic symptom. This disease (unlike hypotension or anhedonia) is not characterized by a breakdown and motor inhibition, so a person reacts to everything sharply negatively and often loses his temper. This leads to outbreaks of uncontrolled aggression.

An attack lasting from a couple of minutes to one hour is called short, from an hour to several days - protracted, long.

At the moment, dysphoria is not included in the medical classifier of diseases (ICD-10). However, the Gender Identification Disorders block is planned to be renamed. In the ICD-11 it will be called "Gender Dysphoria".

Dysphoria: symptoms

Dysphoric disorder is very diverse in its manifestations. The symptom complex depends on the cause of the appearance of this disorder.

So in people with epilepsy, the symptoms of dysphoria can appear at any age, they increase as the underlying disease progresses and fade during periods of remission. The most pronounced anger and hostility, auto-aggression, depression. There will also be a decrease motor activity, lethargy, speech disorders.

With residual-organic lesion of the central nervous system dysphoria in children manifests itself at the age of 7-9 years. Will come to the fore sharp drops mood, inappropriately acute emotional reaction on what is happening, aggression directed at others, mental and physical disinhibition.

But there are common, most common signs of this disorder.

1. A mild form of dysphoria is characterized by grouchiness, vindictiveness and resentment, cynicism, causticity, disappointment in everything, loss of interest in life, inertia. Surrounding people usually consider that a person is “with a complex character”, “just strange”, “quirky”.
2. The severe form is characterized by melancholy, gloom, anger, hostility towards others, increased aggressiveness, a sense of hopelessness, despair. Patients may forget about committed acts of violence after the end of a dysphoric attack. The patient has high risk become addicted to alcohol or drugs.

Close people may not notice pathological changes in the character of a sick relative for many years, because the emotion shown by a person corresponds to the situation that has occurred (gets angry because of an unfair reprimand, is in anguish and despondency after a quarrel with a soulmate).

Causes of dysphoria

Dysphoria can occur against the background of many mental or neurological abnormalities. Such as:

• Schizophrenia;
• Withdrawal syndrome in drug addiction;
• Depression;
• Anxiety neurosis;
• Insomnia;
• Body dysmorphia ( mental disorder, in which a person is too fixated on some feature of his appearance, his body);
• sociopathy;
• Emotionally unstable borderline personality disorder;
• Cushing's disease;
• hypoglycemia;
• Hyperthyroidism.

This disease is also observed in post-traumatic stress disorder or excessive acute reaction on the current stress, chronic pain.

There are several particular forms of this disease.

Postcoital dysphoria

It occurs after intercourse. Along with relaxation, a wave of sadness, longing and irritation rolls over a person. In men, this condition is caused physiological problems(for example, hormonal disorders). In women, postcoital dysphoria most often lies in the field of psychology: disappointment in a partner, dissatisfaction family life, lack of self-esteem.

epileptic

This form of dysphoria is often observed in patients with epilepsy. Patients should be treated for the underlying disease, as dysphoric disorder is only a consequence.

Symptoms of dysphoria most often occur before a seizure, but may terminate it or serve as an equivalent.

premenstrual dysphoria

This disorder occurs in about 5-8% of women. Scientists are still trying to find the cause of this disorder. It is believed that it appears due to an inadequate response of the brain to the normal fluctuations of hormones in the body.

Treatment may include oral contraceptives, antidepressants, neuroleptic drugs, changing the diet, learning stress management techniques, drawing up a plan for physical activity.

gender dysphoria

This type of violation is very different from the previous ones.

Gender dysphoria (identity crisis, gender identity disorder) is characterized by rejection of one's physiological gender and violations in emotional sphere associated with it.

Gender identity is an individual's awareness of his psychological gender. That is, a person understands which gender he belongs to by way of thinking, character, habits. When an individual physiologically belongs to one sex, and psychologically to another, there is identity crisis. The person may refer to opposite sex or mixed, going beyond the binary system of a man-woman. So in 2012, an American, through a court, won the right to be called a person of the third gender.

Causes of gender dysphoria

Primary gender identity begins to form in a child in the first year of life. An example is the gender behavior of parents. If the family has a masculine mother or a feminine father, it is highly likely that the child will have an identity crisis. The second common reason for the violation of gender identity is the desire of parents for a baby of a different sex. A mother who dreamed of a girl subconsciously (or quite consciously) seeks to raise a feminine boy; dad, who wanted a boy, makes the girl go fishing with him, go to football, forbids wearing feminine clothes and shoes with heels. This leads to a distortion of gender identity.

Symptoms of a Gender Identity Crisis

identity crisis light form expressed in the so-called "gender discomfort". Toddler girls can serve as a striking example of this concept. Severe dysphoric disorder leads a person to seek an operative gender change. In some cases, it can be combined with schizophrenia or other serious mental illness.

A person with gender dysphoria feels self-doubt, vulnerability, hopelessness, disappointment in himself and in life, unwillingness to contact those who do not accept his true essence. It should not be forgotten that transgender people and transvestites face ridicule and unreasonable aggression against them on a daily basis.

An identity crisis may be temporary. After proper treatment the psychological state of the person returns to normal. It should also be noted that not always a sex change operation justifies the expectations of a transgender. This speaks of serious violations in the field of gender identity.

Treatment of dysphoria

The first stage of any treatment is a thorough examination and staging accurate diagnosis. The SHVOPS test (Comprehensive Assessment Scale) helps to identify dysphoria. mental state). There are also several methods for diagnosing gender identity, one of which is the S. Bem questionnaire.

At the second stage, the doctor selects individual plan treatment. It may include drugs for the treatment of the underlying disease (antiepileptics, neuroleptics, barbiturates), relief of symptoms of dysphoria (treatment of depressive episodes with antidepressants, suppression of outbreaks of aggression with sedatives).

deal with the heavy psychological state group or individual psychotherapy helps.

Dysphoria - pathological change in the emotional sphere, which may signal serious problems. Lack of proper treatment can lead to serious irreparable consequences. If you notice symptoms of dysphoria, do not delay the visit to the doctor.

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Gender dysphoria (gender identity disorder) is a disease in which an individual does not accept his gender, inherent in him from birth.

A man or woman is not comfortable in his body, the individual wants to change his gender.

Gender dysphoria and homosexuality are two different things.

Human gay feels comfortable in his body, but he is attracted to people of the same sex.

If a person suffers from gender dysphoria disorder, then psychological level he will feel like a person of the opposite sex, which means sex drive heterosexual.

Individuals with this disorder are considered complete, both psychologically and intellectually. There are exceptions, for example, in the presence of episodes of schizophrenia or some other mental illness, then the delirium of a sex change is possible.

In this case, the individual can be sure that some kind of influence has been carried out on him, which may result in a change in gender. Due to the fact that such complaints among patients are too frequent, surgical interventions require a preliminary thorough study of the patient's mental state.

The protection of the rights of a person with gender identity disorder in our country does not have a regular basis, society treats them very negatively, and there are many stereotypes and prejudices towards such people, in which case attacks of unreasonable aggression arise.

The reasons

The causes of gender identity disorder are little studied, due to the fact that gender dysphoria was entered into the reference book. medical classification recently.

The biological basis of this disease is one of the most convincing claims. If the mother during pregnancy is susceptible to certain diseases, if there are hormonal disruptions, then in the future there may be various violations in the psychological perception of the child, including in gender perception.

If the mother has overproduction male hormone testosterone, the result is bad influence of this hormone on a female child, because it is responsible for masculinity in the future. Similarly, estrogens affect the male child.

However, there is no pattern. An excess of one or another hormone does not always lead to consequences. Cases of hormone therapy are quite frequent, and if gender misperceptions occurred each time, then there would be significantly more people with gender identity disorders.

Gender dysphoria is the result of a mismatch between chromosomal and external sex. girls can suffer adrenogenital syndrome and boys with androgen insensitivity.

Even in infancy, the gender of the child may be incorrectly determined, due to the opposite type of upbringing, when a boy is brought up as a girl, and a girl as a boy. This occurs in severe forms of the disease. Therefore, it will not be superfluous to have a genetic examination that helps to accurately determine the sex. These cases are not pure gender dysphoria, but they are very similar. There are a number of other diseases of the endocrine system that cause conflicts between psychological and biological gender.

There is another reason that can cause gender dysphoria. The so-called hidden hermaphroditism. AT medical practice there were cases when men who wanted to change their sex went through a series of medical examinations, as a result of which underdeveloped female organs were found.

Nowadays Small child undergoes numerous ultrasounds, up to three times during the first year of life, so situations of late detection of opposite genital organs are practically reduced to zero. But not so long ago, not more than a quarter of a century ago, there were such cases. Now this is happening only in remote regions. On the given period The most common hypothesis is about developmental disorders during pregnancy.

Symptoms and classification

The Benjamin scale is a system of criteria by which you can study the symptoms of gender identity disorder. It is designed to study dysphoria in men, but it can be easily modified for women.

1. Pseudo-transvestism. More mild form dysphoria. At this disorder a person feels comfortable in his body, in accordance with his sex determined at birth, leads normal life, finds a partner, has children and does not show any obvious signs disorders. However, from time to time he feels the need to try on clothes of the opposite sex, but most often, in order to get a new sexual experience, he can change clothes with a partner. Some simply fantasize, are interested in literature about transvestites. Such people can have any sexual orientation: be homosexual, heterosexual, or bisexual. Such people do not think about changing gender.
2. Fetish transvestism. These people live in comfort with their biological sex, are mostly heterosexual, with only rare exceptions bisexual. Dress up to get excited. Some wardrobe items these people can always wear. Changing gender is not their goal. Hormone therapy is also not needed. The desire to have two names is allowed - male and female. Sometimes psychotherapy may be needed.
3. True transvestism. People do not fully identify with their gender. Use underwear or any other items of clothing that are characteristic of the other sex constantly. Orientation is related to wardrobe preferences. A person is heterosexual, but when disguised, he will choose an identical partner. The change of gender is neutral. In this case, hormone therapy can even improve the quality of life. However psychological correction fruitless.
4. Transsexualism non-stop. A person feels difficulty in determining gender, cannot accurately say who he is: a transsexual or a transvestite. Often changes clothes when possible, but changing clothes is not enough for him. He does not feel comfortable in his body and in clothes corresponding to his gender. Can lead a long life, characteristic of the opposite sex. Doesn't always experience sexual attraction and most often bisexual. Interested in the operation, but not in a hurry to do it. In this case, hormone therapy is considered quite effective, which will help to adapt in your body.
5. True transsexualism of moderate severity. These people feel one hundred percent that they belong to the other sex. Hormone therapy and wardrobe changes are not effective, but they have a place in the patient's life.
6. True heavy transsexualism. People feel so uncomfortable in their bodies that they are even ready to commit suicide. They are homosexual in terms of biological affiliation, they choose heterosexuals as a partner. Helps make life easier hormone therapy or an operation.

Video on the topic: “Principles of the work of the medical commission on gender reassignment“. Seminar for people with transsexualism. Leading - psychiatrist Solovieva Nadezhda Valentinovna.

In the most severe cases required surgical intervention. If a woman changes sex to male, she undergoes the removal of the female genital organs, the uterus.

The penis is formed from local and artificial tissues. If a man wants to become a woman, then the male genital organs are removed, and the female ones are formed.

Sex reassignment people claim that their level and quality of life has improved significantly after the operation. Legislation different countries puts forward different conditions in order to allow the operation, as well as to its scope.

According to some reports, depressions and neuroses resulting from gender dysphoria are effectively corrected by antidepressants. There were cases when it was possible to achieve high level social adaptation.

A documentary about an ordinary teenager, John, in every way except one - he was born a girl. His diagnosis is gender dysphoria. Now he has to go all the way to becoming a boy.

With pronounced forms of the disease, it is possible to place the patient in a psychiatric dispensary. Great importance has psychological support

If unable to correct psychological disorders traditional methods, the patient is shown a reception hormonal drugs, which help "turn from a man into a woman or vice versa. In severe cases, sex reassignment surgery is performed.

When changing the female sex, the uterus, vagina, ovaries are removed, and the penis is formed from the removed tissues. Implants are implanted into the body - testicular substitutes. Reverse surgery involves the removal of the penis, testicles, and shaping of the vagina.

Gender is a disease that requires great attention from others. An inattentive attitude, a rude word can do much harm to the patient. Prevention of the disease comes down to proper sexual education, correction of neuropsychic breakdowns. It is important to make a person feel more confident, calmer, since in no case should he feel inferior, superfluous.