Defense Date
2026
Document Type
Thesis
Degree Name
Master of Science
Department
Clinical Psychology
First Advisor
Jared Keeley
Second Advisor
Ann Haynos
Third Advisor
Jaclyn Sadicario
Abstract
The diagnostic classification of gender dysphoria in the DSM-5-TR elicits a number of clinical, political, and philosophical concerns, ranging from those that are diagnostic and taxonomical in nature to those that fall within the domains of ontology, phenomenology, and hermeneutics. Part of the reason for the complexity of studying the diagnostic and nosological validity of gender dysphoria as an extant diagnostic classification is that, unlike many disorders, gender dysphoria is inextricably tethered to identity. While the recent change from gender identity disorder to gender dysphoria has nominally removed the status of disorder, in practice, both clinicians and the general population tend to conceptualize the experience of gender dysphoria as a pathological one—and with such a conceptualization, the social stigma many gender nonconforming and gender diverse individuals experience is compounded. Despite the ethical concerns that surround the nosological decision to maintain gender dysphoria as a diagnosable experience, it is difficult to justify the removal of the classification from clinical taxonomy, given that a diagnosis is often a prerequisite to receiving essential gender-affirming care. Amid the important dialogues about whether to maintain or remove gender dysphoria as a diagnostic classification, it is important to consider the content validity of the current diagnostic criteria. The diagnostic criteria for gender dysphoria that exist in the present clinical model have their origins in problematic, transnormative conceptualizations of gender identity, and, as such, capture only a limited understanding of diverse gender identities. On both practical and theoretical grounds, it is necessary to develop diagnostic criteria for gender dysphoria that move away from the cisnormative and transnormative frameworks present in the construct’s current form. The construct’s focus on binary models of gender identity guides clinician decision making processes—e.g., some clinicians may impose an inaccurate, but popular, schema that assumes only binary representations and expressions of gender exist or are valid. This promotes a type of ontological and phenomenological essentialism, as well as a set of narrative expectations for clinicians interviewing gender diverse individuals. Such essentialism fosters epistemic injustice, given that it is not uncommon for clinicians to justify not providing a diagnosis of gender dysphoria by claiming an individual is confused or will experience regret, which overwrites the individual’s phenomenological experience. The current study aims to address gaps in the current research and conceptualizations of gender dysphoria and the lived experiences of gender-diverse and transgender individuals. At the time of writing this, I am not aware of any extant research that qualitatively analyzes the phenomenological perspectives of both gender-diverse/trans individuals and clinicians. Phenomenological interviews were conducted with a trans and gender-diverse participant group (n = 8) and a clinician participant group (n = 6). The community sample reported themes that indicate a mixed alignment and misalignment with their lived experience and the diagnostic criteria for gender dysphoria; while some participants felt the criteria described their experience, they indicated that they feel the criteria are not appropriately suited for gender identities that do not align with binary norms. Furthermore, the community sample also noted the pathologizing qualities of both the diagnostic classification and the language used in the criteria. The clinician sample similarly indicated that they feel the existence of gender dysphoria as a diagnostic necessity is otherizing and pathologizing, and that the content of the criteria is not valid for the heterogeneous presentation of gender identities and experiences of dysphoria. This study suggests that gender dysphoria has poor content validity for trans and gender-diverse individuals who do not identify as a binary gender identity. Furthermore, the language and conceptual assumptions of the criteria were discussed as being pathologizing and otherizing in their current form. Future versions of the DSM should revise the diagnostic classification of gender dysphoria to reduce pathologization and increase content validity.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
4-22-2026