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Short Paper: Gender Dysphoria

Short Paper: Gender Dysphoria

Short Paper: Gender Dysphoria

Based on the articles on gender dysphoria, write a short paper about the influence of acceptance, parenting styles, and how these can directly steer a child’s gender identity.


Moreover, think about society today and acceptance of varied gender roles compared to the 1950s. What is different today in parenting styles compared to the 1950s? Additionally, think about the criteria and changes made in the DSM in the most recent version (DSM-5) compared to earlier, outdated versions. Short Paper: Gender Dysphoria
Also, consider and explore society’s influence on gender dysphoria in your argument. Is there a direct correlation to gender identity and society or not?
Paper should be 3-5 full pages and 3 resources formatted in APA.



1. Library Article: Gender Dysphoria: Two Steps Forward, One Step Back
This article examines the newly revised diagnostic criteria for gender dysphoria and illustrates the substantial step forward in understanding the population it encompasses.
The article discusses there is much improvement in the definition, there still leaves room for growth in labeling such population. This article is required for all of this module’s tasks. Short Paper: Gender Dysphoria

Lev, A. I. (2013). Gender dysphoria: Two steps forward, one step back. Clinical Social Work  Journal, 41(3), 288-296. doi: 0447-0

2. PDF: Gender Dysphoria  This article provides an overview of the newly established guidelines for gender dysphoria adopted by the DSM-5.
The article reviews the criteria for a gender dysphoria diagnosis and areas in which there still remains a struggle for those with this diagnosis. This article is required for all of this module’s tasks.

3. Library Article: Gender Stereotypes in the Family Context: Mothers, Fathers, and Siblings
This article explores gender stereotyping of children by their parents. The study examines parental expectations and stereotypes and how these differ compared to siblings of different genders. This article is required for all of this module’s tasks.

Endendijk, J. J., Groeneveld, M. G., van Berkel, S.,R., Hallers-haalboom, E., Mesman, J., &  Bakermans-kranenburg, M. (2013). Gender stereotypes in the family context: Mothers,  fathers, and siblings. Sex Roles, 68(9-10), 577-590.  doi:

4. Library Article: The Early Development of Gender Differences
The study examines the inception of gender differences and influence of developmental roles. This article is required for all of this module’s tasks.

McIntyre, M., & Edwards, C. (2009). The Early Development of Gender Differences. Annual  Review of Anthropology, 38, 83-97. Retrieved from

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    Gender Dysphoria: Two Steps Forward, One Step Back

    Arlene Istar Lev

    Published online: 18 July 2013

    � Springer Science+Business Media New York 2013

    Abstract The long-awaited DSM-5 has finally been

    published, generating controversy in many areas, including

    the revised diagnostic category of Gender Dysphoria. This

    commentary contextualizes the history and reform of the

    pathologization of diverse gender identities and expres-

    sions, within a larger perspective of examining psycho-

    logical viewpoints on sexual minority persons, and the

    problems with continuing to label gender identities and

    expressions as pathological or disordered.

    Keywords Transgender � Gender � Diagnosis � GID � Gender dysphoria � Gender identity � LGBT � Trans � LGBTQ

    Sexualities keep marching out of the Diagnostic and

    Statistical Manual and on to the pages of social

    history. Short Paper: Gender Dysphoria

    Gayle Rubin 1984, p. 287.

    Clinical Social Work has just celebrated its 40th anni-

    versary, and this volume marks the first special issue devoted

    to lesbian, gay, bisexual, and transgender (LGBT) mental

    health and psychotherapy. The lives of LGBT people, people

    who are now reclaiming the word queer as a proud self-

    descriptor to encompass the term LGBTQ (Tilsen 2013),

    have changed dramatically in this same period of time.

    LGBTQ people were leading clandestine, marginalized

    lives, ostracized by family and friends, unable to have chil-

    dren (or retain custody of them), living with a constant threat

    of unemployment, creating false narratives about their social

    lives to appease others and protect their private lives. Now

    LGBTQ people have the potentiality of full lives—out,

    proud, married, with families, serving in the military,

    working for the government—with strong communities and

    federal laws that protect us against bias-related violence.

    Forty years ago, I was a 15-year-old Jewish working-class

    adolescent, growing up in the tail end of 1960s counter-cul-

    ture, and deeply in love with my best girlfriend. My journals

    were full of endless, painful monologues about her, about

    society, and about where I would fit into the grownup world I

    would soon be entering. I wasn’t exactly closeted—I called

    myself bisexual—but I was filled with angst and confusion

    and drowning in myriad social messages of what it meant to be

    a lesbian (which in my journals I spelled ‘‘lesibean’’ because

    even simple access to seeing words that reflected my experi-

    ences in print was non-existent). I did not know how to talk

    with my mother, my friends, my boyfriend, my girlfriend

    about my emerging queer identity. What could be the future

    for a young dyke? Where could I find a home, a job, a lover, a

    life? And if I found my way to therapy, what would the psy-

    chotherapist say to me that would affirm my identity? What

    education did she have, what trainings had he attended, what

    journal articles could she/he have read to help her or him help

    me to grow to be a healthy secure and very queer adult?

    In entering into this discourse with you, the reader, I must

    start with a moment of silence, for all that has not been said

    within the therapy professions, within social work and family

    therapy—the professional communities I call home—these

    past 40 years. The LGBTQ communities have been hard at

    work informing politics, changing policy, opening minds,

    indeed transforming the world in many ways—and our clin-

    ical communities have followed along, taking a mostly pro-

    gressive, supportive stance on issues as they have arisen,

    incorporating a ‘‘gay-affirmative’’ approach into our clinical

    A. I. Lev (&) School of Social Welfare, State University New York at Albany,

    Albany, NY, USA



    Clin Soc Work J (2013) 41:288–296

    DOI 10.1007/s10615-013-0447-0



    practices (Levy and Koff 2001), but as a social work com-

    munity, I wonder if we have done enough (Levy and Koff

    2001). Have we been at the vanguard of advocacy and pro-

    gressive change, or have we merely followed the evolving

    trends (Hegarty 2009)? I hope that this inaugural issue heralds

    a change not just in direction, but in conceptualization, so that

    LGBTQ issues become not a ‘‘special issue,’’ but are incor-

    porated into the framework and organization of the journal. I

    was taught many years ago to always ask the questions ‘‘Who

    is not present at the table? Whose voice is not being heard?’’

    The challenge of fully incorporating LGBTQ clinical

    knowledge into the mainstream of clinical social work is to

    deconstruct heteronormative thinking, to queer the discourse. I

    will try in the words that follow to move this discussion past

    ‘‘gay-affirmative’’ therapy, and to imagine a more queer psy-

    chotherapy, one that truly challenges the pathologizing of

    LGBTQ lives, and heteronormativity of non-queer ones. I want

    to look at the role that diagnoses play in the development of

    identity, communities, and the therapeutic gaze. The context of

    this discussion is the change from Gender Identity Disorder to

    Gender Dysphoria in the fifth edition of the Diagnostic and

    Statistical Manual of Mental Disorders (DSM-5; American

    Psychiatric Association (APA) 2013), but it is by necessity a

    wider discourse about both sexual orientation and gender

    identity, the social and political context of the holding envi-

    ronment we call therapy, as well as an emerging queer sensi-

    bility that challenges the hegemony of pathological labeling.

    The shift in diagnostic nomenclature initiates a potential shift in

    clinical conceptualization from gender nonconformity as

    ‘‘other,’’ ‘‘mentally ill,’’ or ‘‘disordered’’ to understanding that

    gender, as a biological fact and as a social construct, can be

    variable, diverse, and changeable, and existing without the

    specter of pathology. De-centering the cisgender assumption

    that normal people remain in the natal sex (cis) and that dis-

    ordered people change (trans) is at the root of debate regarding

    gender diagnoses in the DSM and the battle for their reform.

    I became a social worker 25 years ago to work with what

    we then called the gay community. I fought and lost the battle

    as the Chair of the ‘‘Gay Issues Committee’’ of the New York

    State Chapter of the National Association of Social Workers

    (NASW) to change the name to the ‘‘Lesbian and Gay Issues

    Committee’’; the word lesbian was still foreboden. Although

    this was over a decade after homosexuality had been removed

    from the DSM, ‘‘gay’’ issues were poorly integrated in my

    social work education. The only time I heard the word trans-

    sexual as a student (the word transgender had not yet been

    coined) was when a teacher said, ‘‘You know that some people

    want to change sex?! Really!’’ She leaned into the class and

    repeated in a loud incredulous whisper for emphasis,

    ‘‘Really!’’ When I became an adjunct professor (in the same

    Social Work program in the late 1980s) and I asked my col-

    leagues how they addressed issues of sexual orientation in the

    curricula, I was met with blank stares. Was there really

    nothing to say about homosexuality now that it was no longer a

    diagnosis in the DSM? Really?! Short Paper: Gender Dysphoria

    However, despite the silence within training institutions,

    there have been many positive changes for LGB people

    socially and politically. In the past few decades lesbian and

    gay people have secured many civil rights. It is worth

    pondering whether these social changes would have hap-

    pened if homosexuality had remained in the DSM. Do you

    think we would be seeing these massive social changes,

    like marriage equality? Throwing off the yoke and stigma

    of ‘‘pathology’’ allowed not only for the coming out of gay,

    lesbian, and bisexual people, but also allowed for legal,

    political, and clinical transformations that could never have

    been granted a ‘‘mentally ill’’ population. How would your

    psychotherapy practice look different than it currently

    does, if homosexuality was still a mental disorder? These

    questions are an important prelude to the discussion of

    Gender Dysphoria in the DSM. Short Paper: Gender Dysphoria

    The acronym LGBT has become a moniker, a catch-all

    expression meant to include a group of people who may not

    have all that much in common. It has become a practice of

    mine, whenever I receive new classroom textbooks, to look

    in the index for the phrase LGBT, and then see what the

    content reveals. Most of the time what is revealed is gen-

    eral information on lesbian and gay people. The B and T

    are too often silent. Although I mentioned above that I feel

    relatively secure that lesbians and gay men are receiving

    competent care when seeking therapy, I do not pretend to

    feel that trusting about the clinical treatment received when

    we toss in the unique issues bisexual people face in either

    heterosexual or same-sex partnerships (see Scherrer, this

    issue for an in-depth discussion regarding bisexual indi-

    viduals). And what about the complex issues transgender,

    transsexual, and gender non-conforming people experience

    within the confines of the consulting room?

    I began to work with transgender clients and their

    families in the mid-1980s. I had no training in under-

    standing gender identity, gender expression, gender dys-

    phoria, or the process of transitioning one’s sex medically,

    legally, or psychologically. In my first sessions with a

    transwoman I will refer to as Krystal the Duchess, I was

    initially baffled, bringing to the sessions not much more

    than a compassionate heart, an open-mind, and deeply

    challenged feminist politic. Krystal arrived in therapy,

    presenting as a mild-mannered, disheveled and middle

    aged depressed man named Norman who lived at home

    with his mother. Norman could have easily been diagnosed

    with various personality disturbances, severe anxiety, and

    perhaps a mild psychotic disorder, and indeed would have

    been if diagnostics were the primary clinical lens I used.

    Krystal then revealed herself to me, bigger than life, a drag

    artist who traveled to New York City on the weekends to

    perform in Greenwich Village; a double-life she had lived

    Clin Soc Work J (2013) 41:288–296 289




    for decades. Krystal disclosed that this was no longer

    performance, she wanted to fully live as Krystal, but felt

    stuck, caught between two genders, two different worlds,

    and saw no way to actualize herself, to become Krystal.

    Frankly, neither did I. Short Paper: Gender Dysphoria

    At the same time, another client was referred to me, a

    young masculine female named Sam, who had come out as

    a lesbian when she was still a teenager, and received

    support from her parents, as well as a gay-affirmative social

    worker. She confided to me: ‘‘I’m not really a lesbian; I’m

    really a man.’’ I asked her girlfriend what she thought of

    this statement, and she conferred, ‘‘Of course, she’s a man.

    If she’s not a man, then I would be a lesbian, and I am

    definitely not a lesbian!’’ I thought this was the worst case

    of internalized homophobia I had ever seen (and I’d seen

    plenty by then), if not a mutual delusion system. I was

    clearly in over my gay-affirmative head!

    Both Krystal and Mel arrived in my office because they

    were told I was an ‘‘expert,’’ but perhaps the only real

    expertise I had was realizing how little I really knew about

    sexuality, sexual orientation, and gender. Being a biblio-

    phile, I spent the next 5 years reading everything there was

    to read on gender identity, transsexualism, Gender Identity

    Disorder, and the political analyses emerging from the

    burgeoning transgender liberation movement. Mix thor-

    oughly, cook on a low heat, and my book Transgender

    Emergence: Therapeutic Guidelines for Working with

    Gender-Variant People and Their Families was born.

    In the years that have followed, I have worked with

    hundreds of trans people, their partners, their children,

    and their extended families. I have worked with hetero-

    sexual, married men well into mid-life who had been

    secretly cross-dressing since they were small boys, and

    had never revealed this to anyone, until they told me,

    indeed until they showed me; I’ve heard this story more

    times than I can count. I worked with butch-identified

    lesbians who wanted to live as men, but their lesbian

    lovers didn’t want to be with men—they wanted the

    particular masculinity that butch women exude. I have

    worked with 5-year-old children who were absolutely sure

    that they were girls, and having a penis did not in any

    way deter them from their convictions; as they matured,

    they are still 100 % sure of this. I have worked with

    many heterosexual couples trying to come to grips with

    whether to allow their teenagers to start hormone-block-

    ers, giving them time to decide whether to begin puberty

    as a boy or as a girl. I have worked with young adults

    who eschew all pronouns, all genders, and call themselves

    queer with a fierce pride. I worked with a Roman Cath-

    olic priest, who lives full-time as a woman now. Trans-

    gender people represent an enormous diversity of

    humanity, crossing all racial, ethnic, class, and cultural

    populations, all ages, dis/abilities, and religions.

    The word transition is used to describe the process of

    changing gender that Krystal and Sam and so many others

    since were describing; it is also a word used during the

    birth of a baby, when the head begins to crown. I have

    spent the last few decades witnessing this transition, the

    crowning, the birth, their re-birth, if I dare to use such a

    term. There is much that I have learned in this process, but

    one thing is perfectly clear, transgender people are more

    like the rest of us—cisgender people, those who do not

    challenge the sex binary—than they are like one another.

    For the most part they are mentally stable—no small task

    given what they face—and when they are not so stable,

    they are unstable in the ways the rest of us are: anxious,

    depressed, and sometimes struggling with deeper mental

    health issues. But their gender is not disordered (Lev

    2005); indeed their gender is quite ordered, just not in

    conventional ways. Short Paper: Gender Dysphoria

    I live in awe of these transformations and the emotional

    cost of these journeys, but in the mid-1980s I was mostly

    just infuriated because one thing was blatantly clear read-

    ing clinical treatises on trans/gender—the entire field

    (small enough at the time that I likely read every tome ever

    written) was built on the exact same pathologizing narra-

    tive that had made homosexuality a viable diagnosis for

    nearly 100 years (Oosterhuis 1997). The story of Gender

    Identity Disorder, and the new diagnosis of Gender Dys-

    phoria, is a narrative of an oppressed people and their

    liberation struggle, amid the psychobabble of gender con-

    formity, mental illness, and medicalization of human

    diversity. Plummer (1981) has said that the ‘‘…realization that one was collectively oppressed rather than individually

    disturbed…’’ (p. 25) was the realization of gay and lesbian people in the 1960s, a realization that began to dawn on transgender people in the 1990s. Short Paper: Gender Dysphoria

    The diagnosis of homosexuality rested on simple het-

    eronormative assumptions about what was ‘‘natural,’’

    ‘‘healthy,’’ ‘‘functional,’’ ‘‘common’’ (it is, after all the

    Diagnostic and Statistical Manual). Within the confines of

    western culture, same-sex love was obviously pathological,

    outside the expected boundaries of human behavior and

    experience. Based on those assumptions, psychological

    theories developed etiologies of ‘‘why’’ someone could be

    like ‘‘that.’’ The answers, based initially in psychoanalytic

    ideology as well as the behavioral and cognitive theories of

    gender acquisition that developed later, led to theories of

    faulty child-rearing and mother-blame: homosexuality in

    men was caused by over-involved mothers and distant

    fathers, causing a disturbance in proper gender socialization

    (see Stoller 1966); (in classic pre-feminist psychoanalytic

    theory, there was a mostly silence about what caused les-

    bianism (Kitzinger 1993). Decades later these ideas seem

    anachronistic, as thousands of lesbian, gay, and bisexual

    people attest to coming from very different family

    290 Clin Soc Work J (2013) 41:288–296




    structures, most whose configuration does not resemble the

    suffocating mother/distant father dynamic (see LaSala, this

    issue for a detailed discussion of this topic). However, my

    review of the literature revealed that these same etiological

    theories were resurrected in the late twentieth century to

    explain transsexualism.

    Few therapists today would treat a lesbian or gay client

    using a lens of causality, nor would they try to assist them

    in living a heterosexual life (and indeed, if they did so, they

    would be going against the ethical and moral standards of

    nearly every professional mental health organization, see

    Anastas, this issue). However, the field of transgendersim

    is only recently coming out (literally) from the shroud of

    etiology. What if gender transitions are a normative part of

    the diversity of human identity? Research from history,

    anthropology, and the biological sciences seem to show

    that non-binary gender identities, gender transformations

    and transpositions, are ubiquitous across human and non-

    human communities, throughout history and cross-cultur-

    ally (see Lev 2004). What if there is nothing disordered,

    dysfunctional, odd, or unnatural about transgendering? If

    transgender is not pathological, then what is it that needs to

    be diagnosed? Short Paper: Gender Dysphoria

    Although Homosexuality was officially removed from

    the DSM in 1973, it was replaced in the DSM-III with an

    only somewhat less noxious diagnosis—Ego-Dystonic

    Homosexuality, which was not removed until 1980. Dys-

    tonic refers to the subjective experience of unhappiness and

    is contrasted with syntonic behavior, or one’s comfort with

    their same-sex desires. The DSM-III stated that this diag-

    nosis should only be used when the client had unwanted

    homosexual feelings and it also stated that ‘‘…distress resulting from a conflict between a homosexual and society

    should not be classified’’ (APA 1980, p. 282). It soon

    became clear that living in a homophobic and heterosexist

    culture left few ‘‘happy well-adjusted homosexuals,’’ and

    given the complexities of internalizing a stigmatized

    minority status, the diagnosis was determined to be biased,

    and was removed.1

    At about the same time that homosexuality was removed

    from the DSM, gender identity diagnoses were included.

    From a contemporary perspective, this appears confusing,

    especially when you realize it was the same men who

    developed the DSM diagnosis for gender identity who were

    the strongest advocates for both the removal of

    homosexuality from the DSM and also the early pioneers

    working with, and supportive of, transsexuals and their

    need for medical assistance in transition (see Drescher

    2010; Zucker and Spitzer 2005). Why would they want to

    pathologize gender identity diversity while we were finally

    liberating homosexuality as a diagnosis? It was thought at

    the time that the inclusion of a diagnostic category would

    legitimize transgender identity and would assist in the

    development of treatment and professional attention for

    this invisible and vilified population. History has indeed

    shown some wisdom in this perspective. However, it has

    also left us 30 years later with a diagnostic category that

    pathologizes a minority community, and potentially inter-

    feres with their pleas for civil rights and acceptance within

    the human family. Short Paper: Gender Dysphoria

    A brief review of this process follows: In the DSM-III

    (APA 1980), two diagnoses were included for the first time,

    one called Transsexualism, to be used for adults and ado-

    lescents, and the second Gender Identity Disorder of

    Childhood. In DSM-III-R (APA 1987), a third diagnosis

    was added: Gender Identity Disorder of Adolescence and

    Adulthood, non-transsexual type, which was removed

    when the DSM-IV (APA 1994) was published.2 Also in the

    DSM-IV the two previous diagnoses were conflated into

    one, Gender Identity Disorder (GID), with different criteria

    sets, one for adolescents and adults, and another for chil-

    dren (see pages 537–538). Additionally, the diagnosis of

    Transvestic Fetishism, a paraphilia, has undergone

    numerous changes in nomenclature and criteria during the

    revisions; all were included in the section on Sexual and

    Gender Identity Disorders.

    For the past few years, there has been a fervent move-

    ment among both trans-activists and professionals to

    remove the gender diagnoses from the DSM, and in lieu of

    that, to at least reform them (see Lev et al. 2010; Winters

    2008a). However, depathologizing gender identity in the

    DSM mirrors the slow process of change in removing

    homosexuality, incrementally through many versions of the

    DSM. As Winters (under pseudonym Wilson) noted back in

    1997, ‘‘American psychiatric perceptions of transgender

    people are remarkably parallel to those for gay and lesbian

    people before the declassification of homosexuality as a

    mental disorder in 1973’’ (p. 15). Similar to the history of

    the removal of homosexuality from the DSM, some head-

    way has been made in the construction of the DSM-5, and

    improvements are slowly evolving, in gradual stages, of

    what appears to be a positive direction.1 Many are not aware that a residual category for homosexuality remained in the DSM-IV under the category of Sexual Disorders Not

    Otherwise Specified [NOS]. This category includes three items, the

    last one was, ‘‘Persistent and marked distress about sexual orienta-

    tion’’ (DSM-IV-TR. 2000, p. 582); ostensibly this could be used for

    anyone struggling with sexual orientation, though I suspect it was not

    often used for heterosexuals struggling with their straightness. This

    has been removed in the DSM-5.

    2 The phrase ‘‘non-transsexual type’’ referred primarily to male

    cross-dressers, but in some ways was a foreshadowing of the

    emergence of diverse gender expressions that might not involve a

    complete gender transition. Short Paper: Gender Dysphoria

    Clin Soc Work J (2013) 41:288–296 291

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