Elightening view of gender dysphoria, and its effects through life stages.

[Carrie Liz]

Yesterday night, I stumbled upon this article.

I know for a long time I've had issues with the term "gender dysphoria," because really all it means is a feeling of being unwell with one's gender. And it really doesn't do much to explain where it comes from, what it is, or how to treat it. This article rectifies these things by arguing for a new term, "Gender Expression Deprivation Anxiety Disorder." In other words, the experience of dysphoria isn't just a feeling of being unwell with one's gender, it's coming from a lack of ability to express oneself's internal gender identity.

I know for me this has been a helpful definition, because just using the term "dysphoria" when I'm feeling bad about myself, it really doesn't say anything, just that I'm feeling bad. And when people talk of being a man or a woman trapped in the wrong body, I didn't know that this really applied to me, because I didn't really feel that strongly about it. I didn't feel "trapped" per se, just a lingering feeling of unhappiness about who I was. The definition as proposed, though, says everything about the problem. That it comes not from just a general feeling of unwellness, but from a lack of self-expression, a lack of being oneself in regards to gender.

This article really helped me to clarify in my mind what I was feeling, and what I have been feeling my whole life. So I highly recommend it. And even if you don't agree with the definition part, this article contains some very profound stories of how gender dysphoria manifests itself through different stages of life. Reading this, SO many of the experiences resonated with me. The experiences from childhood to early adulthood felt like they were hitting me right in the gut in terms of self-application. And some of the experiences from those later in life than me really served as a cautionary tale, as though saying "this is your future if you don't deal with this."

I hope it helps someone else as much as it helped me.

http://www.avitale.com/developmentalreview.htm

The basic summary of this article is as follows:

Living in conflict with one of the basic tenets of existence (Am I male or am I female?) is understandably anxiety provoking. This fact leads me to suggest that Gender Identity Disorder as this conflict is described in the DSM IV, is not an appropriate descriptor. I suggest here as I have elsewhere (Vitale, 1997, 2001) that instead the condition be termed Gender Expression Deprivation Anxiety Disorder (GEDAD). After explaining my thinking on gender expression deprivation anxiety, I will describe how this anxiety, if left untreated, is manifested in each of the five developmental stages of life: confusion and rebellion in childhood, false hopes and disappointment in adolescence, hesitant compliance in early adulthood, feelings of self induced entrapment in middle age, and if still untreated, depression and resignation in old age.

[Paige]

Thanks for posting this Carrie Liz.  It certainly a wake up call to people like me who are older and haven't transitioned.  It definitely sounds like the only way to go is to get on hormones because the GD is never going away.  The Middle Age section really hit home, and  I can really understand the bitterness that could develop as you get even older.

Dr. Vitale's article is definitely something that everyone should read.  I especially think it would be an eye opener for my wife.

[Megumi]

Nice article, the adolescence and early adulthood sections covered my experience to a tee. I think I will send my parents an link to that article to help them understand some of the things that they are confused about right now.

[Mariax]

I remember reading this a bit back, and it shed lots of light on my life experiences to date. A real,.Whait you mean I am not alone? sort of thing.

The way I tended to deal with things, though, was denying gender differences existed, period. Had a heck of a time doing that... but it worked for about thirty years.

[Paige]

The article seems pretty definitive that hormones are the only thing that really help with our situation.   I've never read anything to the point as this.  I wonder how many in the medical community would agree with this paper. 

[JenSquid]

Thank you, Carrie, for sharing this.

Reading this, it seems I fall squarely into Group 3. The descriptions of childhood and adolescent experiences match my own to a T.

I think I may need to show this to my mother. Especially given some of the questions she asked me the other night.

[Jennygirl]

Loved it.

This will probably help a lot of people, thank you for posting it Carrie

[Christine Eryn]

That's one of the most damnedest things I have ever read!    It's like seeing my life story written by someone else word for word, situation for situation. It's actually tough to get through. Much appreciated for finding and posting it!

[foreversarah]

The article seems pretty definitive that hormones are the only thing that really help with our situation.   I've never read anything to the point as this.  I wonder how many in the medical community would agree with this paper.

Haven't had a chance to read the article but it's interesting you bring that up. I could possibly answer that from a medical-legal point of view as I've studied medical law (at least UK medical law). In medical negligence there is the Bolam test. This test says that so long as there is one reasonable body of medical opinion then it is perfectly reasonable to be carried out. So this would mean so long as the person who wrote this is a reasonable form of medical opinion and someone was to follow that, in theory, through the Bolam test, it could be applied.

[Jill F]

Wow.  Just wow.  I think she nailed it.

[Antonia J]

Others have said it, but "Wow" this was perfect.  Thanks for sharing!

[Heather]

I remember reading this some time back, what's weird is I kinda feel like a cross between group1 and group3 but I think I have more in common with group1. I think were I can relate to group3 is because I was kinda shamed into acting more like a boy but the truth was I never tried to actually be a boy and I never developed my own male personality I just copied it from those around me.

As a psychotherapist I have found female identified males (G1) to be clinically similar to male-identified females (G2). That is, individuals in both groups have little or no compunction against openly presenting themselves as the other sex. Further, they make little or no effort to engage in what they feel for them would be wrong gendered social practices (i.e., the gender role assigned at birth as the basis of authority). Although I have seen some notable exceptions, especially in male-identified females, these individuals--at the time of presentation for treatment--are rarely married or have children, are rarely involved in the corporate or academic culture and are typically involved in the service industry at a blue- or pink-collar level. With little investment in trying to live as their assigned birth sex and with a lot of practice in living as closely as possible to their desired sex, these individuals report relatively low levels of anxiety about their dilemma. For those who decide transition is in their best interest, they accomplish the change with relatively little difficulty, particularly compared to G3, female-identified males.

I think this quote pretty much sums up my life so far I never invested in trying to be a male at all. In fact after I went back in the closet when I was 17 I lost total interest in living at all and just went through the motions of living. But I do wish I would have been fully in group3 though it seems like they are the overachievers who make a lot of money and have pretty successful lives.   

[Emmaline]

Awesome article- mind you having to type gedad (gee dad) would be a bitch but I agree wholeheartedly with the description of gender expression deprivation anxiety... that pretty much sums it up.

Whats everyone thinj of gedad?

[Mariax]

https://www.susans.org/forums/index.php?topic=36243.0

Old thread on what I think is the same article.

As for GEDAD, it might depend on how you interpret it. The article seems to define it as not being able to live in your desired gender, but the words "deprivation anxiety" almost make it sound like occasional cross dressing would work as a therapy. For some, maybe, but even as the article indicates, many require hormones to reach balance.

I'm worried about the phrasing because there are people out there still who believe if gender differences in society were abolished, there would be no GID, which isn't true. Saying all people would need to do is be allowed to dress up now and again to "cure" them doesn't describe the experience of many trans folks.

Getting back to what the article does say, I totally agree that my anxiety has only increased as I have aged, and I am now at the breaking point. I see women my age or even older who seem fulfilled in their lives, and I feel a gaping whole in mine because I feel like I have been denied so much. I am very thankful in many ways for what I have been blessed with, but I have always had trouble appreciating it due to constant anxiety and feelings of displacement.

[Carrie Liz]

Yeah, that is an old thread on the same article. But since it's 5 years old at this point, and the conversation didn't really go anywhere, and I felt like that old one was more a discussion topic on whether the "new" wording was appropriate or not rather than bringing it up as kind of a personal-confirmation thing, I thought it was worth re-posting and looking at it with a different context.

[eli77]

I found the article very interesting, but I don't really fit in either of the two categories for male-assigned individuals. There are certainly bits and pieces that I relate to, but it's inconsistent. I fit the G3 model as a child almost perfectly. But I was closer to G1 as an adolescent as I consistently failed to behave as an appropriate guy--yet I still refused to actually admit anything, so everyone thought I was just gay... though I didn't do any dating at all and I actually like girls. I transitioned at 26.

I do think it's important to remember that any model is going to be a best-fit and will invariably have to leave some people out. Basically, it's awesome if you recognize yourself in that article and it helps you to better understand your situation/needs. That's really great! But it's also totally cool if you don't relate to the article; it doesn't make you any lesser or anything. You do you.

I guess I just worry sometimes that people might end up reading things like this, and not being able to relate and end up feeling even more alone and lonely. So if that's you, don't be sad; you are awesome too, promise!

[Lo]

Very interesting, but it still pretty expressly leaves out nonbinary identities. With this paper in mind, it seems like GID actually leaves more wiggle room for us than the proposed GEDAD. One step forward, one step back...

[beaver]

Even though this article focused more on the G3 group, I still saw some insight of what the future might be for a young person who identifies with G2. There is much common ground to be shared between the groups. Recently, I've really been struggling with the denial of GID/GEDAD and fear of transitioning. Logically, I knew I would probably be happier if I transitioned, however, there is still a big emotional road bump of fear (family/friend rejection), anxiety (what if I regret it?), and the sheer amount of will that is needed to get through it all. Just being able to back it up with some hard science and evidence has forced me to look at it clearly and examine future prospects. Looking at what is down the road, and seeing that it really never goes away. Most importantly, what will make me happier?
The downfall of this view, however, is that it seems to present a fairly narrow view of the treatment, where only hormones seems like the only way. I would love to see more research on this subject.

Really liked it, thanks for sharing.

[Tanya W]

Hey Carrie, thanks very much for posting this.

It's funny, for the most part my brain just collapses when faced with reading anything written in a relatively scholarly/academic/research-oriented way. My partner often laughs at this; how my eyes at a certain point glaze over and the article's storyline evaporates for me!

Things are so different with trans/gender/binary/nonbinary stuff. Again and again I have found the precision of such pieces incredibly helpful. Terms are carefully defined. Parameters clearly noted. I have spent most of my life to date in a kind of 'gender fog' - Am I this? Am I that? What do these words really mean: 'this' and 'that'?!? - so the exactitude offers welcome insight!

As for this article in particular, I personally am in the midst of an ongoing struggle to wholly embrace my transgender reality. Things are in a kind of 'step in / step out' phase. I feel a very complete acceptance for an hour or a day, perhaps, then the whole situation drifts into a bit of unreality, uncertainty, and denial. The barely conscious mantra of such times seems to be, 'Oh I can fix this, make it go away.' This piece reaffirms the fact that these feelings do not go away and are, as a result, best accepted and worked with in some sort of appropriate way.

The author does, of course, have a sense of what 'appropriate' looks like. I continue to wonder, 'Can there be other responses?"

Again, thanks for putting this up! Would love to see more.     

[Paige]

The author does, of course, have a sense of what 'appropriate' looks like. I continue to wonder, 'Can there be other responses?" 

That's the million dollar question isn't it?  I'm the exact same way, some days I'm certain, other days I'm completely confused.   Thanks for posting your comment Tanya.