In the past, society considered that most of the sexual behaviours, orientations and identities removed from heteronormativity were due to the existence of psychological problems. Over the years, minority groups have achieved greater social acceptance, while the different studies carried out reflected that these groups did not suffer from any type of pathology.

This is what has been happening little by little with aspects of sexual orientation such as homosexuality and bisexuality. However, in the case of sexual identity, the debate on this issue has been a little longer, with transsexuality appearing in the main diagnostic classifications until recently.

Let’s talk about transsexuality: a gender identity issue or a psychological disorder?

The Concept of Transsexuality

A transsexual is someone who feels the existence of a continuous incongruence in time between their biological sex and their gender identity. This incongruence usually provokes in the person the desire to initiate a process of transformation in order to live according to the gender felt as their own, using elements such as hormonation and surgery.

Gender identity, as the sexual self-concept that each person has of him or herself and the value we give to that identity, is something that is largely socially mediated. Being a man or a woman implies different things according to the society or culture in which we live, implications that may seem more or less close to our own identity.

The above definition of transsexuality indicates the existence of a mismatch between the physical and the psychological . The basic question is whether this feeling of inadequacy is a normal reaction to a difference between the mental and the physical or whether it constitutes a disorder.

Why do some people still consider it a psychological disorder?

Regardless of issues related to tradition and the beliefs of part of the population in this regard, the main reason why transsexuality has been considered a disorder so far is based on the concept of gender dysphoria .

Gender dysphoria

Gender dysphoria is understood as the deep frustration and discomfort that many people have in relation to their own body when they consider that it is not the one they should have, when they consider that it does not correspond to their own gender identity.

This psychological phenomenon can cause great stress and anxiety , in addition to self-esteem problems, depressive and anxiety disorders and the display of isolating and self-hiding behaviours.

It is for this reason that in diagnostic manuals such as the DSM, gender dysphoria continues to be a trigger of discomfort related to transsexuality.

Transsexuality does not necessarily imply dysphoria

However, gender dysphoria should not be identified with transsexuality. You don’t have to want to transform or live as the opposite sex to feel uncomfortable with your assigned gender role, just as you don’t have to feel bad about yourself to want to make that transition.

While it may happen, not all transsexuals feel a deep dislike for their body , or this does not pose a greater problem than the desire to change. For example, there are transsexuals who do not see the need to make a total physical change, opting for hormones and changing their clothes and behaviour in favour of the one they feel most like.

Thus, not every transgender person will have a particularly marked gender dysphoria that causes him or her suffering. In fact, it is possible that even more than suffering, the realization of true gender identity can be experienced as a liberation for those who have had their identity suppressed.

Other arguments against its consideration as a disorder

The conclusions drawn from various investigations reflect that transsexuality is not a disorder, using different arguments for this.

First of all, it should be noted that the existence of an identity is not in itself pathological , so that when dealing with transsexuality the existence of an identity diverging from the biological one could not be considered as a disorder.

Secondly, it is important to take into account the fact that as a rule people who want to change their sex and do so with the appropriate psychological, hormonal and in some cases surgical treatment present an improvement in their quality of life compared to when they had not externalized their sexual identity. In addition, the very consideration that it is a disorder causes manifest damage and high stigmatization to the transsexual population, favoring transphobia and inequality.

Finally, it should be noted that the desire for body modifications such as cosmetic surgery is not considered pathological as long as it does not threaten gender stereotypes. Modifying our weight with a liposuction, changing the shape of the nose through a rhinoplasty or injecting botulinum toxin implies that we do not like what was previously present and we want to change it, without necessarily being cases of Body Dysmorphic Disorder. The same happens with sexual characteristics and identity .

The situation today

Although up to now transsexuality has been listed as a mental disorder in the world’s predominant diagnostic classifications, such as DSM-IV, which includes it as a disorder under the name of Sexual Identity Disorder or ICD-10 (here the term transsexualism appears as a mental disorder), this fact is about to change.

The World Health Organization, which publishes the International Classification of Diseases or ICD, which includes mental disorders (another of the world’s reference manuals, along with the DSM), will publish the next edition of the ICD, ICD-11, in 2018.

As in its previous version (published in 1990) with homosexuality, the WHO will no longer consider transsexuality a mental disorder. Instead, transsexuality will be considered a condition related to sexual health, under the name of gender inconsistency.