Is Transgenderism a Mental Disorder?

Denmark became the first country in Europe to allow transgender individuals to legally change their gender without medical records in 2014.^[1] In 2016 Denmark became the first country in the world to announce that it will remove transgenderism from its list of mental diseases, effective January 1, 2017.^[2] This despite the fact that the World Health Organization lists gender identity disorder—the term medically used to refer to transgender individuals—as a mental disorder in the World Health Organization’s International Classification of Diseases.^[3][4] Likewise, given that transgender individuals perceive themselves differently than the testimony of objective reality, transgenderism meets the definition of a mental disorder according to the Diagnostic and Statistical Manual of Mental Disorders. The American College of Pediatricians explains:

A person’s belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. These children suffer from gender dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder (GID), is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V). The psychodynamic and social learning theories of GD/GID have never been disproved (emphasis removed).^[5]

The classification of transgenderism as a mental disorder may not be politically correct, but with the absence of objective evidence disproving such a classification, the medical community is compelled to treat it as such. Failure to do so would be inconsistent with how psychiatry defines other recognized disorders of assumption. Former psychiatrist-in-chief at Johns Hopkins Hospital and University distinguished professor of psychiatry at Johns Hopkins School of Medicine Dr. Paul McHugh explains:

The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one’s maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.

With body dysmorphic disorder, an often socially crippling condition, the individual is consumed by the assumption “I’m ugly.” These disorders occur in subjects who have come to believe that some of their psycho-social conflicts or problems will be resolved if they can change the way that they appear to others. Such ideas work like ruling passions in their subjects’ minds and tend to be accompanied by a solipsistic argument. [This is the theory that only the self exists, or can be proved to exist, or an extreme pre-occupation with one’s feelings and desires.^[6]]

For the transgendered, this argument holds that one’s feeling of “gender” is a conscious, subjective sense that, being in one’s mind, cannot be questioned by others. The individual often seeks not just society’s tolerance of this “personal truth” but affirmation of it.^[7]

Despite transgenderism’s similarities with other disorders of assumption, the mental health community has come under severe political pressure to declassify transgenderism as a mental disorder, and recent changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) has provided the category of transgenderism with a degree of protective ambiguity. Transgenderism has been reclassified from gender identity disorder to gender dysphoria. According to CNN, “The new DSM refers to ‘gender dysphoria,’ which focuses the attention on only those who feel distressed by their gender identity.”^[8] Additionally, the term “mental disorder” was redefined. According to the previous edition of the DSM, the DSM-IV, “A mental disorder is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.”^[9] However, the DSM-V redefined mental disorder to afford an exception for socially deviant behavior and conflicts that are primarily between the individual and society:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.^[10]

The American Psychological Association has endeavored to use these changes in the Diagnostic and Statistical Manual of Mental Disorders to deny that transgenderism is a mental disorder. On their website they answer the question “Is being transgender a mental disorder?” by saying:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. … Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.^[11]

In other words because a transgender individual is not troubled by their perception of themselves, but only by the reaction of those around them, they cannot be said to have a mental disorder. However, this reasoning is not consistent with all mental disorders. For example WebMD describes psychotic disorders as “distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations – the experience of images or sounds that are not real, such as hearing voices – and delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary.”^[12] Sometimes the individual is not troubled by these hallucinations and false fixed beliefs, but only by the reaction of others to their delusion. The fact that the individual is not troubled by the condition, but only by the reaction of others to the condition, does not disqualify it as a mental disorder.

At the heart of this debate over how to classify transgenderism is the question, “What causes transgenderism?” Is transgenderism a perfectly natural and inborn condition; is it a consequence of social conditioning; is it a psychological disorder, or is it something else? At this point we do not have enough objective data to conclusively determine a cause for transgenderism. This is the conclusion of Dr. Jack Drescher, a psychiatrist who was part of the American Psychiatric Association’s work group on gender identity. Dr. Drescher admits, “‘The truth is we actually don’t know what it is. Is it a mental disorder or does the cause of gender dysphoria lie somewhere else? We don’t know what causes it.’”^[13] Theories abound, but we should continually keep in mind that these are merely theories. In the meantime, we are compelled to rely upon the only objective data that we have.

Be sure to Read Timothy Zebell’s book Transitioning: A Biblical Understanding of Transgenderism.