Which statement is NOT among the diagnostic criteria for gender dysphoria in adolescents and adults?

• A. Marked incongruence between experienced gender and primary/secondary sex characteristics
• B. Desire to be treated as having an alternate gender
• C. Desire to have primary/secondary sex characteristics of the opposite gender
• D. Distress about incongruence unrelated to gender identity

Answer: (D)

Gender dysphoria in adolescents and adults is diagnosed when there is a persistent incongruence between the person’s experienced/expressed gender and the sex assigned at birth, accompanied by a strong desire to be of the other gender (or to have the other gender characteristics) and a strong wish to be treated as the other gender, with distress or impairment related to this incongruence. The statement describing distress about the incongruence that is unrelated to gender identity does not fit the criteria because the distress must be directly tied to the incongruence and its impact on functioning. The other options reflect legitimate elements of the diagnostic criteria: incongruence with primary/secondary sex characteristics, desire to be treated as the other gender, and desire to have the opposite gender characteristics.