Inside out and outside in: Towards a clinical and dialectical model of gender dysphoria amongst transgender and gender non-conforming youth

Abstract

Gender dysphoria refers to the mismatch between gender identity and assigned sex at birth. In order to alleviate gender dysphoria, some youth seek medical treatment – gender-affirmative care – to align body with gender identity. A better understanding of subjective experiences of gender dysphoria may enable clinicians and youth themselves to improve care. The present study explores subjective experiences of gender dysphoria by synthesising 12 qualitative studies and conducting in-depth interviews with 15 adolescents referred to gender affirmative care. The results indicate that gender dysphoria is related to sexuality, bodily sensations, relations to other people and social norms, the process of coming out and an ongoing negotiation of gender in everyday life. Furthermore, the results indicate that the participants struggle to unify conflicting gazes on themselves from the outside with the gazes on themselves from the inside, which ultimately leads to gender dysphoria. Based on the results, a clinical and dialectical model is suggested to better conceptualise gender dysphoria as a compound and individually diverse phenomenon that needs to be negotiated in different contexts.