12 Chapter 1 Table 1. Criteria for a diagnosis of gender dysphoria in children according to the DSM-5 * Gender dysphoria in children is defined as a noticeable incongruence between one’s experienced/expressed gender, and their birth-assigned gender. This incongruence should be lasting at least six months, as manifested by at least six of the following: • An intense desire to be of the other gender, or an insistence that one is the other gender (or some alternative gender that is different from one’s birth-assigned gender) • A strong preference for cross-dressing (wearing typical clothing from the gender opposite to the birth-assigned gender), and a strong resistance to wearing typical clothing from the birth-assigned gender • A strong preference cross-gender role in fantasy play or make-believe play • A strong preference to do activities, or play with toys and/or games that are stereotypically used or engaged in by the other gender • A strong preference for playmates of the other gender • A strong rejection of activities, tops, and activities that are stereotypically used or engaged in one’s birthassigned gender • A strong dislike of one’s primary sex characteristics • An intense desire for the physical sex characteristics that match one’s experienced gender • In order to meet the criteria for the diagnosis, the condition should also be associated with clinically significant distress, or it should significantly impair one’s functioning socially, occupationally, and/or in other important areas of functioning * American Psychiatric Association, 2013 Table 2. Criteria for a diagnosis of gender dysphoria in adolescents and adults according to the DSM-5 * Gender dysphoria in adolescents and adults is defined as a noticeable incongruence between one’s experienced/ expressed gender, and their birth-assigned gender. This incongruence should be lasting at least six months, as manifested by at least two of the following: • A noticeable incongruence between one’s experienced/expressed gender, and one’s primary and/or secondary sex characteristics (in young adolescents, the anticipated secondary sex characteristics) • An intense desire to get rid of one’s primary and/or secondary sex characteristics because of the noticeable incongruence with one’s experienced/expressed gender (in young adolescents, an intense desire to prevent the development of the anticipated secondary sex characteristics) • An intense desire to have the primary and/or secondary sex characteristics of the other gender • An intense desire to be of the other gender (or some alternative gender that is different from one’s birthassigned gender) • An intense desire for society to treat them as the other gender (or some alternative gender that is different from one’s birth-assigned gender) • A strong conviction that one has the characteristic feelings and reactions of the other gender (or some alternative gender that is different from one’s birth-assigned gender) • In order to meet the criteria for the diagnosis, the condition should also be associated with clinically significant distress, or significantly impair one’s functioning socially, occupationally, and/or in other important areas of functioning * American Psychiatric Association, 2013 TREATMENT FOR GENDER DYSPHORIA Not only the acceptable terminology and the number of referrals changed over the years, also the recommendations regarding the (medical) treatment for these children and adolescents have been in motion. Three broad approaches regarding treatment for pre-pubertal children with gender incongruent experiences have been described in the
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