The medicalization of transgender identity has long been a controversial topic, in part due to concerns about further stigmatization of a marginalized group. In 2013, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) was updated to drop the term “gender identity disorder,” and instead adopt “gender dysphoria,” defined as a marked incongruence between one’s gender identity and one’s sex as registered at birth. The update explicitly articulates that gender non-conformity is not in itself a mental disorder, and notes that the condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. The current DSM-5 TR defines gender dysphoria as “clinically significant distress or impairment related to gender incongruence, which may include a desire to change primary and/or secondary sex characteristics.”
Where gender dysphoria poses significant occupational impairment, some transgender or gender diverse individuals consider filing for Social Security Disability benefits. However, the threshold for approval is high, as the claimant must prove an inability to work any job in the national economy, including jobs that only require occasional contact with others.
When evaluating a claim, Social Security Administration (SSA) will consider any diagnosable impairment or combination of impairments that severely impact the ability to work. While not all transgender people experience gender dysphoria, many individuals diagnosed with gender dysphoria have a co-occurring diagnosis of depression or anxiety. The comorbidity of these conditions is not surprising, given the discrimination many transgender and gender diverse individuals have experienced.
However, recent years have seen a positive change in public attitudes, largely thanks to activism and public awareness campaigns. For example, SSA now permits people to self-select their gender in their administrative records is also exploring the possibility of an unspecified “X” sex designation. Hopefully with more acceptance of gender diversity, there will be less need for people with gender dysphoria to claim disability.