Case Conference (Sexual Dysfunction, Paraphilic Disorders, and Gender Dysphoria)

Michael was struggling with Gender Dysphoria in Adolescents, a condition where an individual
experiences significant distress due to the incongruence between their assigned gender at birth and
their true gender identity. In Michael's case, he felt like a male trapped in a female body, leading to
emotional pain and suffering. His distress manifested in a desire to eliminate female characteristics,
including undergoing testosterone treatments for a physical transition. This struggle impacted his
social and familial relationships, causing significant distress, and affected his school performance.
Michael's suicide attempt was a desperate effort to communicate the depth of his pain and a plea for
understanding and acceptance of his true identity as a male.
Diagnostic Criteria Behavior

A. A marked incongruence between one’s Michael is a 15-year-old Caucasian,

experienced/expressed gender and assigned
gender, of at least 6 months’ duration, as
manifested by at least two of the following:
transgender male (female to male), who is
seeking counseling to assist him in beginning
testosterone hormone therapy. Michael reports
knowing that he was a male from the time he
was 7 years old.

1. A marked incongruence between one’s Michael reports knowing that he was a male
experienced/expressed gender and primary from the time he was 7 years old.

and/or secondary sex characteristics (or in

young adolescents, the anticipated secondary
sex characteristics).

2. A strong desire to be rid of one’s primary Michael reported experiencing extreme

and/or secondary sex characteristics because of
a marked incongruence with one’s
experienced/expressed gender (or in young
adolescents, a desire to prevent the
development of the anticipated secondary sex
characteristics).
symptoms of depression when he began
developing breasts. He stated that he tried
everything he could to keep them from growing
and hide their appearance. Michael also felt
hopeless and experienced an increase in
suicidal thoughts whenhe began to menstruate

3. A strong desire for the primary and/or

secondary sex characteristics of the other
gender.

4. A strong desire to be of the other gender (or

some alternative gender different from one’s
assigned gender). .

5. A strong desire to be treated as the other Michael informed his mother that he was a boy
gender (or some alternative gender different and that he wanted to be treated as such.

from one’s assigned gender).

6. A strong conviction that one has the typical

feelings and reactions of the other gender (or
some alternative gender different from one’s
assigned gender).
The condition is associated with clinically
significant distress or impairment in social,
school, or other important areas of functioning
He indicated that he felt alone and he had no
one to talk to about what he was experiencing.
He also did not know what was going on with
him; he just knew he was different from his
peers, and he did not feel like he fit in with
anyone. He began to emotionally distance
himself from the few friends he had.