Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I want to talk about the pathology of being transgender because I see this being discussed online. The problem with the discussion that I’m seeing is that it is trying to make this a black and white issue when it is a grey issue. It does not help us to avoid the nuance of complex issues. The truth of the matter is that being transgender is sometimes considered pathology in the world of psychology, but not always.
It is important to note that the term transgender is an umbrella term for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth. This means that this single term includes a lot of diversity within it. Those who identify as transsexual, cross-dressers, drag queen or drag king, gender queer, androgynous, multigendered, gender nonconforming, third gender, bigender, two-spirit people and others all fall beneath the transgender umbrella. Each of these terms represents a different way that people experience their gender.
In order for a person who is transgender to have pathology due to being transgender, they must meet the criteria for Gender Dysphoria. This is a mental illness that’s defined as “clinically significant distress or impairment related to gender incongruence, which may include desire to change primary and/or secondary sex characteristics.” [1] Not everyone who identifies as transgender meets this criteria.
When a person is evaluated for a psychological disorder, the provider is supposed to consider “the 4 D’s” before diagnosing them with anything. Let’s review those 4 D’s and then we’ll talk about how they factor into all of this.
- Deviance. This is where the provider is supposed to evaluate if the person’s behavior, mental state or mood state is different then what is considered normal for their society.
- Distress. Does having these deviations from society’s expectations cause the person any distress?
- Disfunction. Does having these deviations from society’s expectation cause the person any disfunction?
- Danger. Does having these deviations put the person or those around them in any danger?
When a provider is considering if a transgender person has Gender Dysphoria, they should be considering the above 4 D’s of Diagnosis. Does the person’s behavior, mental state or mood state deviate from what is considered normal? For American culture, identifying as transgender is considered abnormal and thus will qualify the person for deviance. However, they must have one of the other D’s in order to get a diagnosis.
This is where we get into the meat and potatoes of it. Does the person feel distress about their gender identity? If not, they do not qualify for Gender Dysphoria and have no pathology. If they have distress, then they can be diagnosed with Gender Dysphoria and would then be considered as having pathology. The same is true for disfunction. No disfunction means no diagnosis.
Being transgender does put a person at risk for hate crimes, but that isn’t the kind of safety risk that this question is asking. This is asking if the person’s state of mind is likely to lead them to cause themselves or others harm. In some cases, those with Gender Dysphoria are at risk of self harm and suicide.
The nuance that is over looked in most of these discussions is that not everyone who identifies as being transgender also qualifies for the diagnosis of Gender Dysphoria. Partly because not everyone who is transgender would change their bodies if they were given a choice to do so. There are also those who have found peace with their state of being despite feeling that they would rather their bodies be different then they are. Some would like to change their bodies but don’t feel that the risks of surgery and medication are worth the benefits that they would gain from the change. There is a spectrum in the way that people think and feel about this, much the way there is in almost everything in life.
What I think is most important in this discussion is that being transgender itself is never what is considered to be pathological in the field of psychology. Even when a person is diagnosed with Gender Dysphoria, it is not being transgender that is pathological. What is considered pathological is the inability to reconcile the internal and external states of being. That lack of reconciliation is what is considered pathological. And the only treatment that has been shown to reduce the Gender Dysphoria symptoms is to provide gender affirming care which provides that needed reconciliation between the internal and external states of being.
Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like what you read, click on that like button. It really does help! Until we talk again, you take care of yourselves!
Zebra Pig 
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