Differentials
Autogynephilia
SIGNS / SYMPTOMS
Defined as sexual arousal in a birth-assigned male associated with the thought or image of themself as a woman.[2] This is a controversial diagnosis and is not listed specifically as a paraphilic disorder in DSM-5-TR, and is instead given as a specifier to transvestic disorder (see below).[2] The person may seek hormone treatment and/or surgery to obtain female bodily characteristics (usually breasts) but either does not want to change social gender role or makes no more than token gestures in this regard.
Often a greater degree of earlier sexual activity than in gender incongruence/dysphoria. The sexualized element to the desire for female characteristics may not be disclosed to medical professionals. May be present in addition to gender dysphoria, according to DSM-5-TR.[2]
INVESTIGATIONS
No distinguishing tests: diagnosis is clinical.
Body dysmorphic disorder
SIGNS / SYMPTOMS
Patient may abhor and seek the removal of either primary or secondary sexual characteristics but has no sense of wanting any other gender role or plan to change social gender role.
Aside from this preoccupation, function in birth gender role has often been quite good.
Psychosis
SIGNS / SYMPTOMS
Patient's presentation has the psychological texture of a delusion. Patient is not very worried about how others perceive him/her as a member of the other sex.
Often a history of psychosis or delusions. Sometimes negative symptoms or affective symptoms present at the time of interview.
Gender-related delusions may also occur in up to 20% of people with schizophrenia.[2]
Transvestic disorder
SIGNS / SYMPTOMS
Wearing of the clothes of the other sex is associated with sexual arousal. The clothes are often sexualized. The behavior may be accompanied by masturbation. After orgasm there is often a sense of shame and the rapid removal of the clothes, accompanied by a (transitory) resolution never to cross-dress again.
Found almost exclusively in males.
May occasionally be accompanied by gender dysphoria/incongruence, or be a precursor to gender dysphoria/incongruence in prepubertal birth-assigned males.[2]
INVESTIGATIONS
Diagnosed according to DSM-5-TR criteria.[2] (Diagnosis does not appear in its own right in ICD-11)
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